HSE board meeting minutes 16 December 2022

A meeting of the Board of the Health Service Executive was held on Friday 16 December 2022 at 9:00am in the Boardroom, Dr Steevens’ Hospital.

Present:

Mr Ciarán Devane (Chairperson), Ms Anne Carrigy, Mr Aogán Ó Fearghaíl, Mr Brendan Lenihan, Mr Brendan Whelan, Mr Fergus Finlay, Dr Sarah McLoughlin, Prof Fergus O’Kelly, Mr Tim Hynes, Dr Yvonne Traynor, Ms Michelle O’Sullivan

Apologies:

Prof Deirdre Madden

In Attendance for Board Meeting:

Mr Stephen Mulvany (Interim CEO), Ms Mairead Dolan (Interim CFO), Mr Dean Sullivan (CSO), Mr Fran Thompson (CIO), Mr Tom Malone (Interim ND IA), Mr Damien McCallion (COO), Mr Mark Brennock (ND Communications), Dr Siobhan Ni Bhriain (National Clinical Director, Integrated Care), Ms Eileen Whelan (ND T&T), Ms Anne-Marie Hoey (ND HR), Mr John Ward (CTTO), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Office of the Board)

Joined the meeting:

Mr Patrick Lynch (CRO), Dr Philip Crowley (ND Strategy & Research), Dr Phillipa Withero (AND HR), Ms Eithne Fox (AND HR)

Minutes reflect the order in which items were considered and are numbered in accordance with the original agenda.

1.1 Board Members Private Discussion

The Chairperson welcomed Board members to the meeting and held a private session to consider the agenda and papers for the meeting. The Board noted that the Better Together National HSE Patient Engagement Roadmap commissioned by the Chief Clinical Officer was launched on 6 December 2022. This will now move to an implementation plan stage and the Board agreed that it would be added to the workplan of the Safety & Quality Committee.

1.2 Declarations of Interest

No conflicts of interest were declared.

1.3 Chairperson’s Remarks

Committee’s Workplan 2023 Meeting The Chairperson informed the Board that a meeting had been held on the 15 December 2022 to review the Committee workplans for 2023 and plans will now be finalised by the Committee Chairs. The Chair noted that the Board Strategic Scorecard (BSS) Review Group had been established and held its first meeting on the 15 December 2022. It was noted that the final assessment of delivery against the 20 BSS 2022 ambition statements and their related KPI’s and Outputs / Deliverables, will be completed in the coming weeks as part of closing 2022 and setting out the BSS for 2023.

1.4 Correspondence

The Board noted correspondence issued to the Joint Committee on Health dated 13 December 2022 regarding Owenacurra and further correspondence from the Minister for Health regarding the reconfiguration of services at Our Lady’s Hospital Navan (OLHN).

1.5 Minutes of Board meeting

The Board approved the minutes of 25 November 2022.

1.6 CEO Appointment

The Chairperson of the Board advised Board members that Mr Bernard Gloster has been successful in the competitive selection process for the role of Chief Executive Officer of the HSE. Mr Gloster is currently the Chief Executive of Tusla and is expected to take up the position in Spring 2023.

The Board formally approved the appointment of Mr Gloster as CEO in accordance with the provisions of the Health Act 2004 (as amended). Decision No.: 161222/97.

2.1 Audit and Risk Committee

The minutes of Committee meetings dated 09 November 2022 regarding the HSE Capital Plan 2023 and 10 November 2022 were noted.

The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 08 December 2022, as follows.

The Committee’s Workplan for 2023 was finalised and shared with the other Board Committee Chairs.

The Committee reviewed and approved the Internal Audit Plan 2023. An update on the review being undertaken by Internal Audit on the approach to the audit process for HSE funded agencies was presented and the approach was welcomed. The final report will be presented to the Committee when finalised.

An update was received by the Committee on the financial reporting requirements to DoH and DPER and the Health Budget Oversight Group, noting that HBOG meetings had not been held for some time. The Committee emphasised the need to ensure there are agreed financial reporting deliverables and protocols documented between the HSE and DoH, ideally by the end of 2022 or as soon as possible thereafter.

The Committee was presented with special legislative accounts, audited by the C&AG, which were recommended by the Committee for approval by the Board later in the meeting.

He advised the Board that the Committee reviewed and recommended for consideration by the Board, the Compliance Project Report, the objective of which was to design an improved Compliance Framework for the HSE. The report will be presented to the Board at its meeting in January 2023.

The Committee reviewed a number of policy/strategy documents as follows:

HSE Records Retention Policy Revision 2022 which is nearing conclusion and will be brought to the attention of the Board at a future meeting.

The HSE Report on Global Health Programme 3-Year Plan, 2022-2024 and the HSE Policy on Donation of Medical Equipment and Supplies to Developing Countries and Other Countries in Crisis. The Committee welcomed the policy and requested that it be amended to reflect that donations in a cumulative financial year above €2m should be presented to the Board for approval. Both policies are circulated in the Board papers for noting at the meeting.

He advised that the Committee also received an update in relation to the Property Protocol which was welcomed and noted by the Committee.

2.2 People & Culture

The minutes of Committee meeting of 14 October 2022 were noted.

The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 2 December 2022. The Committee’s Workplan was discussed which was shared with other Committee Chairs.

The Chair advised that the Committee received a briefing update on the RHA programme and the HSE Trust and Confidence Strategy 2022 – 2025, which will be presented to the Board later in the meeting.

The Committee had considered a report from the ND HR. She briefed the Committee on the update on Non-Consultant Hospital Doctor (NCHDs) supports which had been discussed at the Committees October meeting and confirmed that National Doctors Training and Planning (NDTP) welcomed the uptake. She advised the Committee that engagement was underway with the Irish Medical Organisation in relation to an NCHD Agreement. Progress has also been made in relation to the Emergency Tax issue for NCHDs.

The ND HR advised the Committee that October 22 – year to date staffing levels show a total growth of +3769 WTE and that current projection to year end is estimated at +4,600 net growth. It was noted that the recruitment of Management and Administration roles exceeded the max target where as other frontline roles fell far short of the minimum target. She outlined actions taken further to the staff survey 2021 to improve staff experience and improve retention noting that work has progressed on the Recruitment Reform and Resourcing Programme.

The Committee welcomed the HR Heat Map which sets out performance against Resourcing Targets presented by Hospital Group and CHO YTD, demonstrating workforce expansion and turnover. CRR 16 - Workforce and Recruitment was also discussed and the Diversity, Equality and Inclusion Strategy 2022-2024 was also presented to the Committee. As part of the International Day of People with Disability on 3 December 2022, the Committee was shown a video, which demonstrated the work the HSE has done and what it plans to do regarding employing those with a disability.

The Committee also welcomed the HSE Developing Organisational Culture - A Guide for the Health Service Executive 2022 document.

The Committee had received an update on the progress with the Consultant Contracts negotiations.

The Board held a discussion in relation to the Consultants Contract which has recently been approved by Government and will now be considered by the consultant representative bodies and their members.

2.3 Performance and Delivery

The minutes of the Committee meeting of 18 November 2022 were noted.

The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 09 December 2022.

He advised the Board that a discussion took place in relation to the proposed Progressing Disability Services (PDS) Roadmap for improved delivery of services for children with disabilities, which includes a huge amount of high quality work but requires further work. He outlined issues considered by the Committee which included deficits in service provision from diagnosis to assessment, the difficulty in recruiting and retaining therapists in the necessary fields, and that the HSE fund rather than provide a lot of the necessary services, which are provided by Section 38 and 39 organisations.

He advised the Board that the PDS Roadmap is not ready to be presented to the Board as yet, and the Committee will continue to work with the COO and team as the PDS Roadmap, which is seen as urgent by the Department and relevant Minister’s, is brought to finality.

2.4 Safety & Quality

The minutes of the Committee meeting of 15 November 2022 and Quality Profile were noted.

In the Chairperson’s absence, Ms Carrigy provided a verbal report on the matters considered at the Committee meeting that took place on 13 December 2022.

She informed the Board that the Committee received and welcomed a briefing on the HSE Patient Safety Together System and noted that the National Open Disclosure Programme ‘Annual Report 2021’ was presented in response to Recommendation Number 32 of the Scally Report, ‘Scoping Inquiry into the Cervical Check Screening Programme’ September 2018.

The Committee were provided with updates on Winter Viruses, Autumn Vaccination Programme, Therapeutics and Streptococcus Surveillance and the CCO advised that the HSE Covid-19 Vaccination Programme was awarded the Project Management Institute Public Sector Project of the Year and the Greatest National Impact Project of the Year for 2022 on 24 November.

The Committee were also briefed on the National Screening Service, OEST, National Cancer Programme, Update from the AMRIC team on CPE, Public Health Reform Update and the NQPD Division and the CCO had also provided the Committee with progress updates on Our Lady’s Hospital Navan, Letterkenny University Hospital, Interim Model of Care for Long Covid and Letterkenny University Hospital. The Committee suggested inviting AMRIC to present to them in 2023.

The Committee were presented with updates from the ND Acute Operations with regards to the implementation of recommendations for three Internal Audit Reports: ‘Compliance with the National Ambulance Service Guidance on Patient Non-Transport (December 2020)’, ‘Acute Operations the National Clinical Programme for Anaesthesia and College of Anaesthetists Model of Care for Anaesthesiology (2019)’ and ‘Briefing Note ref Implementation of recommendations - Report on Compliance with HSE Standards on Post-mortem Practice and Procedures’.

The Committee also considered the Quality & Safety Profile from the October data cycle as presented by Dr. Healy. A report on the October 2022 workshop was also included this month, and a briefing paper on Quality Profile Report Ambulance Turnaround Times was presented by the Director of the National Ambulance Service. A presentation was made on The Irish Hip Fracture Database (IHFD), which was set up to measure the care for all patients over the age of 60 who suffer a hip fracture.

2.5 Technology and Transformation Committee

The Chairperson of the Technology and Transformation Committee provided a verbal update on the matters discussed at the Committee’s Workshop of 28 November 2002, the purpose of which was to allow Committee members the opportunity to discuss key priorities of the Committee with the CTTO, CSO and CIO, which included the Electronic Health Record (EHR), the eHealth strategy the eHealth portfolio update, and a summary of the eHealth Programmes currently underway, and progress of the 2023 Capital Programmes which were all considered by the Committee.

The next meeting of the Committee is scheduled for 17 January 2023, where the Terms of Reference and Workplan will be discussed.

The Board welcomed the new format of the CEO report which sets out high level end-of-year highlights/achievements for each EMT area, key operational updates, high level synopses of the Board Strategic Scorecard and strategic items of note and their respective linkages to the HSE Corporate Plan.

The Board reviewed and discussed the key aspects of the CEO monthly report and supporting papers, which had been circulated prior to the meeting.

The CEO informed the Board that the transfer of Disability Services from the Department of Health (DoH) to the Department of Children, Equality, Disability, Integration and Youth (DCEDIY) is expected to take place in March 2023.

In relation to CAMHS, the CEO provided an update on the engagement with the families on preliminary findings on the audit of the North Kerry consultant and separate findings regarding audit of NCHD files. The Safety and Quality Committee will continue to be briefed on this.

The CEO provided an update on the development of the PDS Roadmap which aims to address the significant difficulties surrounding the implementation of the Progressing (Children’s) Disability Services policy, including the fallout out from the high court judgement around Assessment of Need. There will be further engagement with the Performance and Development Committee and the Board in January 2023.

The Board noted the Our Lady’s Hospital Navan (OLHN) Reconfiguration – Phase 1 Extended ambulance by-pass briefing paper that that been provided and received an update on the ambulance by-pass protocol change which commenced on Wednesday 14 December 2022. The Board considered up to date information concerning patients waiting for admission to Our Lady of Lourdes Hospital Drogheda and additional ambulances dispatched. The Board emphasised that services should continue to be carefully monitored, and management will continue to work towards the necessary wider reconfiguration of the OLHN Emergency Department.

The Board noted a response is being prepared to recent correspondence received from the Minister which raised a number of queries in respect of the wider reconfiguration of OLHN.

The CEO provided an update on operational services including the rise in Covid-19, the influenza cases and the pressures to services as a result. A discussion took place concerning the Sláintecare Elective Hospitals and Surgical Hubs and the preliminary business cases recently approved by Government for the Cork and Galway Elective Hospitals which are expected to be operational by 2028.

The Board were advised that work has commenced, in collaboration with DoH, on the Government decision to change 4 hospices from section 39 to section 38 status. This will involve the staff of these 4 organisations becoming public servants with access to the public service salary scales and other terms and conditions, including access to public service pension schemes.

The Board welcomed the development of the National Screening Service Strategic Plan 2023 to 2027 and also noted Dr Gabriel Scally’s final progress review of the implementation of the recommendations from his Scoping Inquiry into the Cervical Check screening programme provided assurance that the NSS had accepted and implemented all recommendations. It was also noted that the NCS Laboratory at the Coombe hospital is now being progressed to operationalisation before the end of 2022 and planning for the implementation of the phase 1 of the Cervical Check patient-requested review process is underway.

The Board was informed that in relation to the National Service Plan 2023 (NSP), engagement is ongoing between the HSE and DoH in relation to the NSP. It is likely that some changes will be sought formally by the Minister in relation to how financial issues and risks are referenced in the plan, and the Board will be updated when specific details are available.

The Board welcomed the development of the Global Health Programme 3-year plan and the HSE Policy on Donation of Medical Equipment and Supplies to Developing Countries and other Countries in Crisis.

The CEO presented to the Board, the proposed Strategic Focus topics for discussion for 2023. The Board accepted and approved the Plan, and agreed that a focus on research be included, with the topic having a broad scope for different types of research within the health and social care system being included in the Performance and Delivery Committee Workplan.

The Board welcomed the development of the Trust & Confidence Strategy, which was one of the main objectives of the Board Strategic Scorecard. The ND Communications advised the Board that the aim of the strategy is to learn about trust and confidence and translate this learning into practical action, to measure public trust and confidence in the HSE on an ongoing basis, and use the results to make service improvements. It was agreed that an update will be brought to the Board in March 2023 as a strategic discussion item.

In response to questions from Board members in relation to the provision of the drug Kaftrio to children between the age of 6 -11. The Board were advised that there is a current disagreement with the supplier due to an apparent change of approach by them to the agreement in place which will have significant financial costs for the State. A briefing paper will be circulated to the Board on the issues involved.

The CEO advised the Board that, due to the timing of the meeting, the full year data for the December Board Strategic Scorecard is not yet available, and will be presented to the Board at their meeting in January 2023.

4.1 Corporate Risk

Corporate Risk Register [CRR] as of Q3 2022. The ND GR presented this item to the Board noting that under the Code of Practice for the Governance of State Bodies it is the responsibility of the Board to ‘review management reporting on risk management and note/approve actions as appropriate’. The HSE Board approves the Corporate Risk Register on an annual basis.

The Chair of the Audit & Risk Committee (ARC) confirmed that the CRR had been presented and discussed at their meeting on 08 December and was recommended to the Board for approval.

The Board approved;

1. The Corporate Risk Register (CRR) as of Q3 2022
2. The proposal to align the annual Board approval of the CRR with the Annual Report process
3. Noted the general risk update and approved the proposal to defer the Risk Appetite Statement review until Q1 2023.

Decision No.: 161222/98

A discussion took place concerning CRR 04 Access to Care, and the CRO advised Board members that the risk description will be revisited, and an update will be available in the Q4 2022 CRR.

4.2 Property Transactions

The Board approved the following property transactions which were recommended by the ARC for approval:

1. Proposed granting of lease for property to Voluntary Organisation in Co Galway for a nominal fee Decision No.: 161222/99
2. Proposal for Replacement of the Laboratory Facilities at University Hospital Galway and Annex Decision No.: 161222/100

4.3 Contract Approvals

The Board approved the following contracts which had recommended by the ARC for approval:

1. Proposed entry into a construction contract for improvement works at the Mental Health Facility, Cork Decision No.:161222/101
2. Contract Approval Request for supply of Cylinder and Bulk Medical gases. Decision No.: 161222/102

4.4 Special Legislative Accounts

The Board approved the following special legislative accounts which had recommended by the ARC for approval:

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

The Board 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. Decision No.:161222/103 5.

5.1 Recruitment, Reform & Resourcing Programme

The ND HR presented a paper on the Recruitment Reform and Resourcing Programme which is initiated to address the significant resourcing challenges faced by the health services.

She explained that Slaintecare identified the need for change to the delivery of care in Ireland, moving from a hospital centric delivery of care model, to a more community-based model of care. In support of this plan the HSE developed the People Strategy 2019 – 2024, outlining the Organisation’s commitment to increase its capacity, delivering a health and social care service that meets the needs of the population and attracts and retains the very best staff. In addition, the HSE Corporate Plan 2021 – 2024 outlined the Organisation’s priorities to improve the health service and the health and well-being of people living in Ireland and identified ‘Supporting our People’ as one of the key enablers.

The Board discussed the challenges that the HSE is facing regarding sustained and significant demand for qualified health and social care professionals. This demand is projected to significantly increase in the coming years due to social and environmental factors such as an ageing population and healthcare workforce, health service developments that require more healthcare workers, and local and global talent shortages that impact on talent supply. As the HSE exits Covid-19, existing challenges to recruitment and retention of a skilled healthcare work-force are compounded by substantially increased investment in healthcare to deliver Sláintecare, and the requirement to increase the number of qualified health care professionals. This is against a backdrop where there are changing workforce expectations which requires greater flexibility, agility and creativity.

Furthermore, unprecedented global shortages in qualified health care professionals are impacting the ability to staff services, due to competing internationally for talent, while stemming the flow of domestically qualified professionals to other geographies and industry.

A discussion was held regarding gaps in recruitment in a number of specialties. The Board were advised that the number of undergraduate places has increased recently but that a recent report produced by ESRI in relation to acute hospital services projections showed that Ireland is not producing enough graduates. The Board were advised that work with Universities is underway to increase undergraduate supply. ND HR advised that services are looking at challenges in terms of sourcing courses abroad and investigating how to potentially sponsor people training abroad.

The Board considered the ongoing staff recruitment and retention challenges noting that in relation to HR YTD figures, that despite recruiting more staff in 2022 than in any year pre-COVID, the level of staff turnover is likely to exceed what would have expected by year end. The Q3 year to date figure of 7.3% (2021 full year was 7.7%) turnover has been significantly influenced by COVID-19, including international travel re-opening and retirement or decisions to leave the HSE being deferred.

The Board noted that in 2023, the HSE aims to increase the size of the workforce by 6,000 staff which will represent one of the largest ever annual increases in our staffing. This additional 6,000 is only counted after the HSE has recruited some 10,500 staff to replace those that will retire or leave during the year. Significant efforts are being made to address complex challenges in workforce planning and recruitment while maintaining our focus on strengthening the retention of our existing workforce. This includes advancing the Safe Staffing Framework and encouraging and enabling staff to work at the top of their licence. The ultimate aim is to become an ‘employer of choice’ by providing a rewarding and fulfilling workplace for the HSE’s most valuable asset –people.

In responding to these challenges the Board welcomed the Recruitment Reform & Resourcing Programme which has identifies two overarching Strategic Programmes of work, both of which work together to develop the HSE’s capacity to recruit and resource effectively: The Recruitment Operating Model aims to modernise how recruitment in the HSE will be delivered bringing the selection decision and control closer to the point of service delivery, ensuring we have the right people with the right blend of skills in place to deliver our services. This model will support the development of the RHAs. The Resourcing Strategy aims to empower services to attract, develop, retain and engage the workforce that will deliver safer, better health and social care services for the people of Ireland.

The Board expressed their condolences on the death of Private Seán Rooney, who was serving in Lebanon, acknowledging Private Rooney came forward and provided critical support in the establishment of the Covid Vaccination Centre at O’Reilly Hall, UCD in South Dublin as well as subsidiary centres.

The Chair thanked Board Members and Management Team members for their time.

No other matters arose.

The next meeting of the Board will take place on 27 January 2023.

The meeting concluded at 2.45pm.