Governance and Administration
The Chairperson welcomed Board members, EMT and HSE officials to the meeting and noted that the meeting had been convened to consider the National Service Plan 2023 (NSP), the Capital Plans for Buildings and Equipment and for eHealth and ICT in advance of their adoption.
No conflicts of interest were declared.
National Service Plan 2023
Board members considered with the CEO and accompanying Executive Management Team members the following documentation which had been circulated in advance of the meeting:
- National Service Plan 2023
- Capital Plan 2023 for Buildings and Equipment
- eHealth & ICT Capital Plan 2023
The CEO and CSO presented to the Board the final draft NSP 2023 and Capital Plans 2023 which are to be submitted in line with legislation to the Minister for Health within 21 days of receipt of the Letter of Determination (LOD). The Chair of the Performance & Delivery Committee advised that Draft 1 and 2 of the NSP 2023 was previously considered by the Performance and Delivery Committee at their meetings of 2nd and 8th November 2022 and based on the Committee’s feedback, the CSO advised that the final draft of NSP 2023 was now being presented for adoption by the Board.
The Chairs of the Audit & Risk Committee and Technology & Transformation Committee provided an update to the Board in relation to the Capital Plan 2023 and eHealth & ICT Capital Plan 2023, which were brought to their respective Committees, and advised that both Plans were endorsed, subject to the Committees recommendations being appropriately reflected. The ARC Chair suggested that going forward red line versions of Reports should be brought to the Board and Committees when being asked to review updated drafts.
The CEO informed the Board that the NSP 2023 had been prepared in a particularly challenging financial and operational context, and the draft for approval before the board seeks in so far as possible, to respond to the Minister’s Letter of Determination and associated priorities. He advised the Board that the Plan seeks to demonstrate continuing progress with key reforms, with a particular focus in 2023 on ensuring effective service delivery during the forthcoming winter, and improving access to key hospital and community services. He outlined that there are particular issues and risks in 2023 in relation to the financial context within which the Plan has been prepared and the continuing workforce recruitment and retention challenges are also clearly signalled within the Plan.
The Board members discussed the challenges, in what is, an ongoing uncertain environment. They discussed the affordability and achievability of NSP 2023 in the context of a challenging operational financial outlook for 2023 which has been detailed in the NSP. The Board noted that, without appropriate additional funding support, this will ultimately result in a significant financial deficit in 2023.
It was noted that a number of issues and areas of risk that has not been possible to provide for financially in 2023 included financial issues and risks relating to COVID-19, Haddington Road Agreement (HRA) hours, non-pay inflation, home support costs, pay costs and private income. Other issues and risks remain within core operational and pensions and demand-led areas. The Board agreed that each of these areas will require careful monitoring and management during 2023, and that the HSE will need to work closely with the DoH to monitor, mitigate where possible, and actively manage a number of these material financial issues and risks. The financial allowance for the ELS (Existing Level of Service) is a particular issue of significant concern. Full delivery of activities in the plan would need further funding being required. Adhering to the financial envelope would mean planned services would not be delivered.
Recruitment and retention challenges were discussed in the context of the LOD setting out a total workforce expansion provided for in the LOD of +6,000 whole time equivalents (WTE). These additional posts will be targeted at the vacancies that remain to be recruited under the NSP 2021 and NSP 2022, together with the posts associated with NSP 2023 service developments and the HRA. The Board noted this additional 6,000 WTE will be in addition to the need to recruit 9,500 staff to replace those that will retire or leave during the year.
In the context of the known financial challenges, the Board considered two options available in the circumstances. One would be to reduce services to try as far as possible to match the funding provided, and the second option would be to continue to provide the services needed by the public. The Board supported the second option of approach to be included in the Plan and acknowledged that this approach would mean that the HSE could run a deficit of over €1.5 bn in 2023, without appropriate additional funding support. The Board requested that this needs to be communicated to the DoH when the NSP is being submitted.
The Board agreed to adopt the National Service Plan 2023, Capital Plan 2023 for Buildings and Equipment and eHealth & ICT Capital Plan 2023 for submission to the Minister for Health for approval, on the basis that the approach adopted within the Plan is communicated clearly to the Department of Health to ensure there is a clear understanding in relation to the challenging financial and workforce context in 2023. The approach in the Plan is to continue progress with key reforms, with a particular focus in 2023 on ensuring effective service delivery during the forthcoming winter, and improving access to key hospital and community services. Particular issues and risks in 2023 in relation to the financial context within which the Plan has been prepared and the continuing workforce challenges are to be clearly signalled within the Plan. Decision no.: 101122/82.
The Board highlighted that the timeline of 21 days for the adoption of the NSP is mandated by legislation and is challenging, and requested that the planning and engagement processes with the Board/Committees commence earlier next year.
AOB
The Chair thanked Board members and EMT members for their time.
The meeting concluded at 19:00.