HSE Audit and Risk Committee Meeting Minutes 9 May 2025

Members Present

Yvonne Traynor (Chair), Anne Carrigy, Michael Cawley, Pat Kirwan, 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), Tony Canavan (REO West North West), Niamh Drew (Deputy Corporate Secretary), Patricia Perry (Office of the Board)

Joined the Meeting

Ciaran Breen, Director State Claims Agency (Item 3), Martin Cormican (HSE Clinical Lead for Laboratory Services Reform Programme)(Item 4), Elaine Kilroe (AND Enterprise Risk Management)(Item 5.1), John Byrne and John Creen (Comptroller & Auditor General)(Item 7.1)

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 14 April 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.

Mr Ciaran Breen, Director State Claims Agency joined the meeting.

3.1 Discussion with Ciaran Breen, Director State Claims Agency re costs of claims under the indemnity schemes

The Chair welcomed Mr Ciaran Breen, Director, State Claims Agency (SCA) to the meeting. Mr Breen provided the Committee with an outline of state indemnity as it applies to clinical claims, operated by the SCA since 2002 through the Clinical Indemnity Scheme (CIS), in respect of the provision of professional medical services.

He outlined a number of issues, which the Committee held a discussion on, in relation to the personal injuries discount rate; periodic payment order legislation; key statistics in relation to total claims for all State bodies; the outstanding estimated liability for the HSE and the cash outlay for 2024. He noted that the cash outlay for the CIS was down 14% on the previous year.

Mr Breen provided an update in relation to the Pre Action Protocol, which would involve strict requirements that must be complied with before clinical negligence claims can be filed in court, and would provide a more honest engagement between claimant and respondent parties in a meaningful and transparent way. He advised that the SCA had consulted with the Department of Justice and the draft Protocol is now with the Office of Parliamentary Counsel to the Government (OPC), with the aim of having a Pre Acton Protocol by the end of year or early next year.

The Committee discussed learnings from claims and the structures required to address issues that are preventable, and how the HSE monitors and learns from claims and settlements experience.

The Committee noted the non-engagement of some health and social care agencies with the SCA. The REO West North West advised that there is a process of learnings from events and that the REOs are liaising with the SCA, which Mr Breen welcomed.

The Committee outlined its support for the SCA and it was highlighted that the Committee had approved an audit entitled HSE Interface with the SCA, which is included in the Internal Audit Plan 2025, and will be brought back to the Committee.

The Committee highlighted its important role in relation to clinical audit and to ensure that reporting is appropriate, and thanked Mr Breen for his update.

Mr Ciaran Breen, Director State Claims Agency left the meeting.

Prof Martin Cormican, Clinical Lead for Laboratory Services Reform Programme joined the meeting.

4.1 Proposed National Clinical Audit Programme for Community Services

As requested by the Committee at the March meeting, the Clinical Lead for Laboratory Services Reform Programme presented to the Committee a proposed programme for National Clinical Audits in Community settings, considering services such as Disabilities, Older Persons, and Mental Health services. The Committee welcomed that a more broader approach had been taken which presented an opportunity to highlight existing assurance processes in place for community services and proposed a phased development of a broader suite of National Audits and Registries.

The Committee discussed the proposed programme and encouraged that a lens on financial savings that can be achieved by each audit in the 4 year programme be included, and assurances that actions are implemented and complied with.

The Committee welcomed and endorsed the proposed National Clinical Audit Programme for Community Services, and supported the inclusion in the bid for New Development funding for the HSE National Service Plan 2026.

Clinical Lead for Laboratory Services Reform Programme left the meeting.

Elaine Kilroe, AND Enterprise Risk Management joined the meeting.

5.1 Q1 2025 CRR Report

The Chief Risk Officer (CRO) presented to the Committee the Q1 2025 Corporate Risk Register (CRR) Report. The Committee noted the 10 Open risks and 6 Watched risks on the Register, of which 4 Open risks were rated High, 6 Open risks rated Medium, changes in residual ratings of two risks, and the closure of one risk.

The Committee noted that the Q1 2025 CRR reflects updates arising from quarterly risk assessments and engagements with relevant senior managers.

The Committee noted risks R001 Delivery of Care, R003 Disruptive Events, R005 Financial Management, R007 Cyber Security, and W002 Covid 19, and held a discussion relating to:

1. R003 Disruptive Events, the Committee noted the National Crisis Management Team exercise report based on a mass casualty incident, which is due at the end August and requested sight of an early draft.
2. R004 Health Care Acquired Infections and Anti-microbial Resistance, the Committee noted that in relation to healthcare infections, the NPR reports on key metrics which are brought to the Performance Committee.
3. R007 Cyber Security, the Committee discussed cyber security risk metrics and the level of training in cyber security. The Committee noted that the Strategy & Reform Committee are monitoring Cyber Security and that the Cyber Security plan was brought to the Committee meeting in March. The Committee encouraged a high level of ambition to ensure readiness for any future cyber attack.

AND Enterprise Risk Management joined the meeting.

6.1 Internal Audit Monthly Report

The Chief Internal Auditor (CIA) provided the monthly report to the Committee, noting that nominations for the role of Audit Liaison have been received from all REOs and relevant Centre Heads. The CIA advised that he has issued guidance to audit staff on achieving the objective to provide recommendations that are clear, practical, and aligned with strategic priorities, recommendations that management can realistically implement and that drive meaningful improvement.

The Committee noted that progress on reducing overdue recommendations in Q1 2025 will be reported at the June ARC meeting, and the National Director National Services and Director, Unscheduled Care Lead will attend the June meeting to discuss IA Report National Ambulance Service (NAS) Fleet Management.

The Chair confirmed that the CIA will meet privately with the Committee on a quarterly basis, and on any given month if required by the Chair or CIA.

7.1 C&AG Audit Update for year ended 31 December 2024

(C&AG officials in attendance)

John Crean, Deputy Director of Audit, and John Byrne from the Comptroller & Auditor General (C&AG) attended the meeting.

The Deputy Director of Audit C&AG provided the Committee with an update on the progress to date of the audit for the year ended 31 December 2024. He advised that the final audit is ongoing and that there are a number of key account areas where information and explanations are awaited. The Committee noted the estimated completion date for all outstanding work for submission to the C&AG of 30 May 2025.

The Committee noted and discussed the matters that may be included in the audit cert relating to Supplier Payment Controls; Non-compliant procurement; Oversight of Grants to Outside Agencies; Vaccines write-off; Storage Costs for PPE and Vaccines; High Earners, Fixed Assets and Patient Income.

The Deputy Director of Audit advised that the final decision on the audit opinion rests with the C&AG and therefore the matters to be included in the audit certificate will depend on his final review.

The Deputy Director of Audit advised that if required he would return in the coming months to discuss the C&AG Management Letter and the audit findings in detail.

C&AG officials left the meeting.

AFS 2024 material changes

The Asst CFO advised the Committee that there are no material adjustments to the AFS report, which was approved by the Board on 23 March 2025. The Committee noted €2m difference in Revenue I/E deficit, no change to the Capital I/E, and that the C&AG asked to consider adding to note 26 Contingent Asset, which relates to funding provided by the Department of Health (DoH) via the HSE to the National Paediatric Hospital Development Board (NPHDB).

AFS - Associated Documentation

The Committee reviewed and noted the following documentation.

• Statement of Internal Control (SIC)
• Operating and Finance Review (OFR)
• Letter of Representation 2024
• Chair’s Comprehensive Report

The Asst CFO advised the Committee that the SIC is being amended and the Committee discussed the narrative for inclusion in relation to the Supplier Payment Controls in the SIC. The Committee were of the view that the risk of duplicate payment still exists given that IFMS has not yet been implemented and that at this time the HSE only performs a limited number of reconciliations of invoices with supplier statements. The Committee requested that plans to mitigate the risk in the meantime should be included the SIC. It was agreed that a Special meeting would be arranged to consider the amended SIC.

7.3 YTD Expenditure

The CFO provided a briefing to the Committee on the YTD Financial Position as at 31 March 2025, noting that the HSE is over the overall expenditure budget by €102.5m / 1.6%, (€66.2m DoH and €36.3m Department of Children, Disability and Equality (DCDE)). He advised that within that the Health Regions are over their respective expenditure budgets by €194.0 / 4.6%, offset by a surplus at the centre of (€91.6m).

In relation to Quarter 1 Projections, the CFO advised that a timetable has been issued to services for the production of a forecast based on the Q1 results, and an initial indication of outlook will be available mid-May with the final forecast available by 30 May 2025.

The Committee noted that a 2025 initial cash forecast based on cash utilisation to April has been produced, which serves as an early indicator of 2025 requirements in advance of the Q1 projection being completed. The CFO advised that two forecasts were produced, a high and low scenario, and outlined that taking the mid-point of both forecasts would give a preliminary cash deficit of €698m for 2025 (DoH €521m / DCDE €178m).

The Committee discussed non-pay savings and activity based funding , and it was noted that a paper would be brought to the Committee’s June meeting in relation to the non-pay savings initiatives that are being co-ordinated by National Finance and Procurement Division, and that the Board Strategic Focus for the Board’s June meeting is in relation to Resource Allocations and an update would be brought back to the Committee at a future meeting.

7.4 Health Budget Oversight Group (HBOG)

The Committee noted that there were no minutes of HBOG available.

7.5 Contract Approval Requests

The CFO 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.

Committee member Michael Cawley left the meeting.

Brian O’Connell, ND, Head Strategic Health Infrastructure & Capital Delivery and Micheál Conneely, ND Capital & Estates joined the meeting.

8.1 HSE National Equipment Replacement Programme - Capital Funding Requirements 2025 to 2029

The ND, Head Strategic Health Infrastructure & Capital Delivery provided a report to the Committee in relation to the HSE National Equipment Replacement Programme (NERP) - Capital Funding Requirements 2025 to 2029. The Committee noted that the aim of the NERP is not to replace all the medical equipment replacement requests but to take a pragmatic approach to mitigating the risk to the patient. It was noted that this paradigm caters for the replacement of the higher clinical risk items and targets these items in a manner that maximises the number of critical equipment items replaced that best supports continuity of safe patient care framed within annual budget constraints.

The Committee considered the report noting that it highlights the current quantum of at risk aging medical equipment assets that the HSE has in clinical use across its wide scope of clinical services with a request to support a 5 year annual NERP funding increase.

The Committee held a discussion in relation to the scope of the previous 2016 Grant Thornton report compared to the report presented, and it was agreed that a note would be brought back to the Committee outlining any improvements and achievements made from previous investment. The issue of medical equipment not being used over weekends was discussed and the Committee asked that it be addressed.

As outlined in the report, three funding scenarios for the replacement of only essential medical equipment items with the goal to further reduce the backlog of at risk aging HSE medical equipment assets over a 5 year period were presented. The Committee noted that Scenario 3 was the recommended approach, whereby the NERP focuses on replacing the most complex and highest value equipment, which would require an increased Equipment Replacement Programme funding.

The Committee approved the recommendation of Scenario 3, subject to the availability of funding and subject to prioritisation of the NERP in the HSE’s annual capital planning process that a funding allocation of up to €136m per annum be provided to the NERP for the period 2025 to 2029.

The Committee also approved that further work is undertaken in relation to equipment utilisation and that options be explored for use of technology to provide current data in relation to same, with a focus on the most high tech equipment.

8.2 Quarterly Report on relevant Property Transactions delegated to the Executive (Transactions from €2m - €10m and relevant property disposals)

The ND, Head of Strategic Health Infrastructure and Capital Delivery provided a summary report on transactions approved between €2m & €10m and low value/nominal CAT 3a transactions for the period of 01 January – 31 March 2025, which was noted by the Committee.

8.3 Building Contracts and Properties

The ND, Head Strategic Health Infrastructure and Capital Delivery presented to the Committee the following contracts.

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

The Chair thanked the Committee and SLT members. The meeting ended at 1.43pm

Terms of Reference: Audit and Risk Committee