HSE Audit and Risk Committee meeting minutes 4 December 2024

Members Present

Yvonne Traynor (Chair), Michelle O’Sullivan, Pat Kirwan, Éimear Fisher, John Moody and Sharon Keogh

Apologies

Kate Killen White (REO Dublin Midlands)

HSE Executive Attendance

Joseph Duggan (Chief Internal Auditor), Stephen Mulvany (Chief Financial Officer), Mairead Dolan (Asst Chief Financial Officer), Joe Ryan (ND Public Involvement, Culture and Risk Management/Chief Risk Officer), Dara Purcell (Corporate Secretary), Patricia Perry (Office of the Board)

Joined the Meeting

Patrick Lynch (ND Planning & Performance)(Item 3), Brian O’Connell (Interim ND Capital & Estates)(Item 3), James Gorman (Unit Manager PPP)(Item 4.3), Alan Brett (A/AND Procurement)(Item 4.5), Elaine Kilroe (AND Enterprise Risk Management)(Item 5.1)David Langton (AND Central Compliance Function)(Item 5.2)

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.

The Chair advised of the approval of Board members Ms Anne Carrigy and Mr Michael Cawley as members of the Committee. Committee members discussed the possibility of appointing an external member with expertise in construction and estate management, and the Chair agreed to discuss with the Board Chair.

1.1 Brief of Board Meeting - 26 and 29 November 2024

The Chair provided the Committee with an update of discussions held at the HSE Board Meetings of 26 and 29 November 2024.

2.1 Conflicts of Interest

No conflicts of interest were declared.

2.2 Minutes

The Committee approved the minutes of 01 and 22 November 2024

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.

2.4 Workplan 2025

The Committee noted the Workplan 2025.

2.5 Meeting Dates 2025

The Committee reviewed the meeting dates and agreed that meetings would continue to be held on Friday each month.

Patrick Lynch, National Director Planning & Performance and Brian O’Connell, Interim ND Capital & Estates joined the meeting

3.1 Future Health Infrastructure Delivery Model

The ND Planning and Performance (ND P&P) presented to the Committee the final draft report regarding the Future Health Infrastructure Delivery: Development of an effective health infrastructure and asset management service function within HSE, which the CEO along with the Infrastructure Division of the Department of Health commissioned to develop proposals for a future healthcare infrastructure delivery model for the HSE. The CEO had asked that the Report be tabled for consideration by the Committee for recommendation of acceptance, and submitted to the Board for its approval at the Board’s December meeting.

The Committee held a detailed discussion in relation to the report and advised that the report would not receive their recommendation to the Board. The Committee requested that the ND P&P and the ND Capital and Estates return to the Committee with clarifications in relation to their queries relating to the Scope of the Report; the wider strategic context for healthcare Infrastructure; internal v contracted capital and estates activity; and the resourcing of health infrastructure projects.

3.2 HSE Sustainable Energy Authority of Ireland [SEAI] Capital Funding Memorandum of Understanding and Funding Agreement

The Committee noted the continuation of the existing HSE/Sustainable Energy Authority of Ireland (SEAI) Memorandum of Understanding and Funding Agreement to cover the period of 2024, 2025 and 2026, with the indicative maximum envelope of funding of 165m (50% to be provided by SEAI). Further updates will be provided to the Committee on the progress of decarbonisation targets as part of the updates provided on the HSE Climate Action Strategy.

3.3 Building Contracts and Properties

The ND P&P and Interim ND Capital & Estates presented the following proposed contracts to the Committee.

1. Contract Award for Multi-Storey Car Park and Enabling Works for the New Somerton Wing at Wexford General Hospital
2. Contract Award for the reconfiguration, refurbishment and fit-out of a HSE owned building to provide a permanent Enhanced Community Care (ECC) Hub and Primary Care Centre at Knocknacarra, Galway
3. Proposed development at Connolly Hospital with the Royal College of Surgeons (RCSI)

The Committee considered with close scrutiny the detail and requested clarification in relation to some contracts, and it was agreed to recommend the contracts to the Board for approval.

1. National Maternity Hospital at St. Vincent’s University Hospital – Programme mobilisation Annex NMH at SVUH Programme; Programmes Board Terms of Reference

The ND P&P provided an update to the Committee, noting the establishment of the new governance arrangements for the Programme and approval of the Terms of Reference which were approved by SLT on 26 November 2024. The Committee discussed the structure and operational linkage of the programme, noting that the programme will sit under the Strategy & Reform Committee but emphasized that it is critical that some parts of the programme also stay within the remit and pre Board scrutiny of the ARC. It was agreed that this would be captured in the Committees Terms of Reference.

The Committee discussed responses to queries relating to the Capital Plan which had been received from the ND Capital & Estates after the November 2024 meeting. The Committee requested that the ND Capital & Estates return to the Committee in the new year with further updates.

4.1 YTD Expenditure and projection to Year-end

The CFO provided a briefing to the Committee on the cash position as of 29 November 2024 and outlook to year-end. He advised that as a result of additional cash management efforts, including additional rebate collections by PCRS, the HSE did not need to utilise any of the additional €1,734m or €161m supplementary funding for DOH and DCEDIY funded services respectively in November 2024.

He advised that proposals on cash management to the end of 2024 were approved by the CEO on 29th November 2024 and notified to the Regional Executive Officers (REOs) for communication to the wider system. This included an additional €200m allocation of cash accelerations to voluntary partners beyond the Revised Final Cash Limits notified at the end of October, and represents the last of any flexibility available to the HSE and all cash points, including directly cashed voluntary providers, who have been advised that no further requests for cash acceleration can be considered to year end, and that it will be necessary for any outstanding 2024 service arrangements to be signed in advance of receipt of additional cash.

The Committee noted that it is expected that the HSE will operate within its cash limits to end 2024, that voluntary partners will be able to pay all essential bills and that there will be no adverse service impacts as a result of cash pressures. The Committee acknowledged the work of the finance team.

4.2 Health Budget Oversight Group (HBOG)

The Committee noted the update from the CFO in relation to the meeting of the Health Budget Oversight Group held on 18 November 2024.

4.3 Special Legislative Accounts

The Asst CFO advised the Committee that in addition to the Annual Financial Statements (AFS) the HSE is required to prepare certain accounts under legislation, and present for consideration and recommendation to the Board the following special legislative accounts, which have been audited by the C&AG:

Special Legislative Accounts

• Patient Private Property Accounts (PPP) as required by Health (repayment scheme) Act 2006
• Hepatitis C Insurance Scheme Accounts as regulated by the Hepatitis C Compensation Tribunal (amendment) Act, 2006.
• Long Stay Repayments Account as regulated by Section 18 of the Health Act 2006.
• Long Stay Donations fund as regulated by Section 11 of the Health Act 2006

The Committee noted that the draft accounts had previously been reviewed at the Committee’s July 2024 meeting, and subsequently these accounts had been audited. The Committee noted the accounts were submitted within statutory timelines, have been audited without any material changes or amendments, and that all 4 sets of accounts were submitted to the C&AG in line with the statutory requirement.

The Committee considered the special legislative accounts and recommended them to the Board for signing as part of the Boards reserved functions. They also nominated the CEO and Chairman to sign the accounts in line with signature protocols as agreed with the C&AG as set out in the paper.

4.4 Controls Assurance Review Process (CARP)

The Asst CFO presented an update on the current status of the 2024 Control Assurance Review Process (CARP), which included metrics and trends as previously requested by the Committee and actions completed since the update in September 2024. The Committee noted the 30% completion rate and the increase in participation of clinical staff in the process. The Committee highlighted the fact that the process is not mandatory and stated that more progress is required next year to ensure that all relevant staff adhere to the obligations to comply with the process.

4.5 Contract Approval Requests

Alan Brett, A/AND Procurement joined the meeting

The CFO presented to the Committee the following Contract Approval Requests (CARs)

1. Single Party Framework for Helicopter Emergency Medical Service
2. Biochemistry Managed Laboratory Service (MLS) for Our Lady’s Hospital, Navan

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

CFO and A/ AND Procurement left the meeting.

Elaine Kilroe, AND ERM and David Langton, AND Central Compliance Function joined the meeting

5.1 Enterprise Risk Management (ERM) Strategic Plan and 2024 Report

The Chief Risk Officer (CRO) presented an update to the Committee in relation to the Enterprise Risk Management (ERM) Strategic Plan and 2024 Report. The Committee noted the status of the ERM strategic plan, and how the working draft has been informed and further developed through feedback and engagement with members of the Committee and regional and national colleagues. The ERM report for 2024, which sets out the key deliverables that occurred in 2024, and informed the final strategic plan was also noted.

5.2 KPMG Compliance Report Implementation

The AND CCF presented to the Committee the first quarterly update in relation to the implementation plan to progress specific recommendations made in the KPMG Compliance report. The Committee noted that three recommendations from the report have been implemented since the previous update in September 2024. The AND CCF outlined that a number of key work streams are being progressed relating to the establishment of a Principal Compliance Obligations Register & Associated Metric Report; Development of the Compliance Framework for the HSE; Maturity Assessment of 1LOD/2LOD Compliance Functions; and the establishment of a Central Compliance Function (CCF) with appropriate resources, which were noted by the Committee.

AND Enterprise Risk Management and AND Central Compliance Function left the meeting

6.1 HSE Internal Audit Plan 2025

The CIA provided a verbal update to the Committee and advised that he has reviewed the plan of auditable topics based on research, analysis and consultation with the IA Team, Senior Leadership Team, the Committee and other stakeholders, and also considered audits from the 2024 plan that were not started due to the non-cooperation notice. Taking into account the new accountability structures in the regions, the CIA is due to engage with the Regional Executive Officers and will then bring the proposed 2025 IA plan for consideration by the Committee to the February 2025 meeting.

6.2 Internal Audit Activity Report Q3 2024 (IA Reports and IA Recommendations Monitoring)

The CIA provided a report to the Committee which included Audit Activity and Plan Status; Key findings from Audit Reports in Q3 2024; Implementation of audit recommendations at 30 September 2024; National Performance Indicator; and open and overdue recommendations.

The Committee noted the update in relation to the Internal Audit Plan Status at 30 September 2024; with 16 audit reports issued in Q3 2024 and an outline of the key findings of those reports.

The Committee noted the moderate improvement in the audit ratings (Satisfactory, Moderate, Limited and Unsatisfactory), but highlighted their concern that circa 50% remain in the categories Unsatisfactory and Limited.

The Committee discussed a number of audit reports and requested that a focus be included in 2025 in relation to centralized contract management within the HSE and service providers.

The Committee considered the audit reports relating to Project Governance - eReferrals Project Centre and the Governance Audit – Service Introduction, and agreed that both reports be referred to the Strategy & Reform Committee.

In relation to the implementation of audit recommendations, the Committee noted that the overall open recommendations had reduced by 45 since Q2 2024, however, the timely closure of recommendations by agreed due dates, remains an ongoing issue, with the share of overdue recommendations remaining in excess of 80%. The Committee discussed the National Performance Indicator percentage rates and the issue of the co-ordination of recommendations in the regions relating to both Internal Audit and Risk. The CIA advised that a discussion had been held in SLT and that he will be meeting the REOs in in the coming week to agree a framework, and would further update the Committee at a future meeting.

6.3 Implementation of Global Internal Audit Standards 2024 & Compliance with the Code of Practice

The CIA advised the Committee that the revised Global IA Standards, organised into five domains, were recommended for adoption in 2024, with mandatory application from the start of 2025. The Committee noted that a self-assessment was carried out by Internal Audit which identified five elements with work ongoing to fully implement as soon as possible.

In relation to the Internal Audit Code of Practice, the CIA advised the Committee that a self-assessment for HSE IA on each of the 36 principles of the Code of Practice took place, and outlined the results and considerations that arose from it, which were noted by the Committee.

The CIA advised the Committee that the Internal Audit Division releases Internal Audit reports under Freedom of Information (FOI), on a quarterly basis after they have been considered by the Committee and the SLT. Further to a recommendation by the Public Accounts Committee (PAC) he advised that the HSE will now publish a list of reports completed by its internal audit team on the HSE website, and if a report is requested it will be released without undue delay. The Committee welcomed the transparency of providing access to reports and discussed possible exposure of control weakness which could be exploited. The CIA advised the Committee that all reports go through the FOI process, which considers confidential information. The Committee asked for analytic data on the number of hits to the website page, be made available at a future meeting.

There was no further business.

The Chair thanked the Committee and SLT members. The meeting ended at 12.55pm.

Terms of Reference: Audit and Risk Committee