CEO and Head of Corporate Affairs joined the meeting
4.1 CEO briefing to Board
The Chairperson welcomed the CEO to the meeting.
As previously requested by the CEO to the Chair, the three Board members identified, Anne Carrigy, Matt Walsh and Michelle O’Sullivan, to be in reserve for potential future functions in regard to University Hospital Limerick (UHL), left the meeting and recused themselves for the duration of the CEO briefing to the Board on the Report from Justice Frank Clarke. On the conclusion of the CEO’s UHL briefing, the three Board Members rejoined the meeting.
4.2 CEO Monthly Report
Members of the Senior Leadership Team joined the meeting
The CEO reported to the Board on a number of the key significant areas as set out in the CEO Monthly Report. Focus discussions were held on the following areas:
Discussions were held in relation to urgent care with October 2024 seeing a return to higher demand in unscheduled care, with attendances for the year to date 8.4% higher than the same period last year. Demand has grown in all sites (-1) with growth rates in one hospital as high as 14%. Acuity rates remain steady with admittance rates at 25.7%, a slight drop from 25.9% last year. This reflects an additional 76 patients needing inpatient care per day. Trolley numbers remain below 2023 levels at 11.3%. However concern remains as the numbers are growing ahead of the expected onset of seasonal viral and respiratory illness. Specific focus and oversight plans are in place to allow for every possibility of achieving the same improvements this winter as last, when set against previous years.
The Board discussed trolley numbers in some of the most challenging sites and the difference in figures, and queried the reasons, noting what has worked well in certain hospitals and the lessons learned should be implemented in other hospitals going forward.
In relation to Disability Services, the Board welcomed the engagement with the CEO and a member of the Board, and were advised that discussions took place with the Secretary General of Department of Children, Equality, Disability, Integration and Youth (DCEDIY) on the need for the approach and models to be fundamentally reconsidered.
The Board discussed the Financial Position and the settlement in June, which included a number of savings and efficiency targets with an acceptance that an addition to the €1.5bn would be required on a temporary basis in 2024. The temporary addition to the €1.5bn was envisaged to be €0.2bn, bringing the revised supplementary to €1.702bn, and the Board noted the cash position of €1.749bn which has been granted in the supplementary.
The Board noted that the employment controls continue to work effectively in respect of full-time employment, and that a body of work is to be completed in Agency staffing. Agency conversion to full-time positions of 500+ positions has been approved to services, with each position realising a 20% cost saving. The CEO advised that the Pay and Numbers Strategy (PNS) continues to be the subject of industrial relations challenges with planned lunchtime protests and ballots for industrial action. The CEO advised that he was satisfied that the current approach and controls are appropriate with REOs having the discretion to fill posts prioritised by them while remaining within their position and spend limits.
The Board requested that in 2025, an employment dashboard by region, heatmap and update on POCC operating within their scope be included in the CEO report.
The Board noted that the Productivity and Savings Taskforce met on the 08 October 2024, and that there is a critical focus on developing the approach to and use of Activity Based Funding (ABF). The CEO advised that he anticipates having an updated position on the organisation’s readiness for and limitations in this particular space. He advised that productivity continues to be a focus in the approach to and understanding of best use of resources across the system.
In relation to organisational change, the CEO advised the Board that the Integrated Health Area (IHA) managers took up their posts on 01 October 2024, and responsibility and accountability has transferred from the Community Healthcare Organisations (CHOs) and Hospital Group (HG) Senior Management Teams to the new Health Region Executive Management Team (EMT) and IHA Managers. The detailed design phase of the future state Integrated Service Delivery (ISD) model is underway, featuring engagements with REOs/IHA Managers and other key stakeholders, including patients and service users, internal clinical and operational representatives, and voluntary providers to progress ISD design. The Board noted that there is an ongoing programme of extensive consultation / partnership working with staff representative groups, and Fórsa engagement continues to be facilitated by Workplace Relations Commission.
The CEO informed the Board of a new online system for Adult Safeguarding which went live for the Safeguarding and Protection Teams in the six health regions for the case management of safeguarding, enabling greater visibility and learning across the system. It will assist approximately 130 staff managing approximately 18,000 concerns annually.
Board Strategic Scorecard
The CEO confirmed that two scorecards, #9 Enhancing Bed Capacity and #15 Capital Infrastructure, reported a downgrade in their rating from 4 to a 3. One scorecard, #8 Prevention and Early Intervention, reported an upgrade in its rating from 3 to a 4, and all other scorecards maintained their rating. The Board approved the Board Strategic Scorecard for October 2024, reflecting August 2024 data, for submission to the Minister for Health and DCEDIY.