HSE board meeting minutes 24 November 2023

A meeting of the Board of the Health Service Executive was held on Friday 24 November 2023 at 9:00am via video conference.

Present:

Prof Deirdre Madden (Deputy Chairperson), Mr Brendan Whelan, Mr Aogán Ó Fearghaíl, Mr Fergus Finlay, Dr Yvonne Traynor, Dr Sarah McLoughlin, Mr Tim Hynes, Ms Anne Carrigy, Prof Fergus O’Kelly, Ms Michelle O’Sullivan and Mr Matt Walsh

Apologies:

Mr Ciarán Devane

In Attendance for Board Meeting:

Mr Bernard Gloster (CEO), Mr Brian Murphy, (Head of Corporate Affairs), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

Joined the meeting:

Mr Stephen Mulvany (CFO), Mr Damien McCallion (COO), Mr Patrick Lynch (A/CSO), Dr Stephanie O’Keeffe (ND Operations Planning), Mr Mark Brennock (ND Communications), Dr Philippa Withero (AND HR), Dr Philip Crowley (ND Strategy & Research), Mr Pat Healy (ND Clinical Programme Implementation and Professional Development), Ms Geraldine Crowley (AND ECC Programme & Primary Care Contracts)

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 Deputy Chairperson welcomed members to the meeting and provided an update to the Board during their private session on several matters.

1.1 Declarations of Interest

No conflicts of interest were declared.

1.2 Chairperson’s Remarks

It was agreed that matters relating to Employment Control & Industrial Relations would be discussed with the CEO.

1.3 Ministerial Correspondence

The Board noted correspondence from the Chairperson to the Minister for Health of 20 November 2023 regarding Child and Adolescent Mental Health Services (CAMHS).

1.4 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 25 October 2023.

2.1 CEO Report (including Board Strategic Scorecard)

The Deputy Chairperson welcomed the CEO to the meeting and the CEO Report was taken as read. The CEO reported to the Board on a number of the key significant areas as set out in the report relating to operational matters, strategic objectives, Ministerial priorities and organisational change. He noted that the reporting of data had been impacted on by the current industrial action.

Discussions were held on the following aspects of the report.

Board Strategic Scorecard (BSS)

Noting the impact of industrial action on data accuracy, the CEO reported that some results are concerning and that he had asked the planning unit to consider how to move to the next step in maturity of the BSS and to consider the targets signed up to in the National Service Plan (NSP) regarding critical development outcomes such as listed in the BSS. The CEO agreed with the Board that a review of each of the Scorecards would be carried out at the December meeting with the BSS National Lead in attendance. This will allow Board members to input any considerations for amendment for 2024, as this is a continuously maturing process.

The Board approved the BSS for November 2023, reflecting September (available) data, for submission to the Minister for Health, and a copy to be sent to the Minster for Children, Equality, Disability, Integration and Youth.

Unscheduled Care Management Plan

The CEO provided a briefing and update to the Board on the four components of the UEC Plan: Avoidance Operations, ED Operations, In Hospital Operations and Discharge Operations. The CEO informed the Board that the HSE is facing into challenges this winter period and that trolley waits and pressures will be a feature of the services but that the focus is to ensure that these are not only to the minimum extent possible but also that there is a pathway to continuous improvement available.

A clear priority of the winter period will also be a focus on older and more frail people who are to be the most urgent of all our services, including where necessary, their care experience while in ED awaiting admission.

The CEO added that communication with the public on options for care and regular proactive reporting on the patient flow data (Trolleys, delayed transfers of care (DTOC)) will feature more strongly in the coming weeks and months.

The Board noted that this period of the year is when more challenges emerge and welcomed the operational focus on measures to tackle the challenges including Flu, Covid and respiratory syncytial virus (RSV) together with additional guidance on discharge planning to reduce DTOC to avoid moving too early to a formal Crisis Management mode.

Children’s Health Ireland (CHI) Organ Retention

The CEO informed the Board that he has received a briefing on this matter and the postmortem policy is being adhered to within the system and that he is satisfied with compliance. The Board were informed that 24 organs at CHI Crumlin have been identified as requiring a plan for sensitive disposal. A full review of all organs and relevant information has been completed by CHI at Crumlin and a tailored plan has been developed for each individual case. CHI Crumlin have a project team in place and there is a plan to commence communications with families later this month.

Patient Safety Protocol

The Board were informed that the HSE and CHI oversight work under Mr Nayagam, appointed to review matters associated with Spinal Surgery, continues. The priority remains to conduct a risk assessment of the full range of domains of surgical practice associated with the findings of the completed review reports and to make recommendations in accordance with HSE Lookback Policy by year end.

The CEO also noted that within the organisation restructuring process he has made provision for a more enhanced and defined Patient Safety Unit at both national and regional levels within the HSE.

Childrens Disability Network Teams (CDNTs)

It was welcomed that the National CDNT Training Programme, building team competencies, is now 70% delivered with the remainder to be completed by Q1 2024. The Chair of the Planning and Performance Committee noted that CDNTs had been discussed at the Committee at its November meeting and that the Committee were supportive of all ongoing work in this area and would welcome further involvement going forward.

Expansion of Specialist and Advanced Practice Services and Roles within services

Progress to date on the Expansion of Specialist and Advanced Practice Services and Roles within services was welcomed by the Board, noting that the development of the Clinical Nurse Specialists (CNSs) role in enabling the patient to move through the system and receive care in the most appropriate time and in the most appropriate setting. However, it was noted that the majority of the CNSs are still based in the acute service and the number outside of that service is minimal in comparison to the care needs of the population to be served. It was agreed that the COO would provide further details on the recent developments in these roles and service provision including administration of IV drugs in step-down facilities and nursing homes.

Employment Control & Industrial Relations

The Board noted that the CEO had issued a further notice on 10 November 2023 informing the system that all posts were paused other than those expressly exempted in the notice. The Board discussed with the CEO the impact of the recruitment pauses. The CEO informed the Board that the system has arrived at the point where the organisation needed to address the fact that the organisation was on course to exceed 2023 funded workforce target, and this is neither affordable or sustainable.

The CEO informed the Board that the current Industrial Relations issues are impacting on capability and that there is ongoing engagements with the Work Relations Commission (WRC) and Fórsa Union. He noted that further escalation of the action is likely.

In response to questions from Board members on potential resolution of the issues, the CEO said that once the 2024 Pay and Numbers Strategy was agreed, each region would be in control of their own area and responsible for ensuring compliance within the Strategy. The issue remains challenging, but the CEO noted that in 2024 the system will be consolidating the now unprecedented and expanded workforce and range of services they provide.

Organisation Change

The CEO informed the Board that the successful candidate for CTTO post has withdrawn, and he will revert to the Board on this at the December meeting.

An update was provided in relation to the recruitment competition of the six Regional Executive Officers (REOs).

The CEO presented the final Centre high level design, the Board requested that consideration be given to the area of Quality Improvement within the planned National Safety Unit and the CEO agreed to consider. The Board also discussed with the CEO the number of direct reports to him as presented in the plan.

Resource Management

The CEO confirmed that the uptake of the covid / flu vaccinations by Health workers has been low to date and would encourage all staff get the vaccine to protect themselves and the people they look after.

The CEO provided a briefing to Board on the actions taken by the HSE in relation to the incidents in Dublin City Centre on the evening of Thursday 23 November 2023 and the concerns regarding the wellbeing of HSE Staff. The Board acknowledged and commended all of our staff for the work they did in very difficult circumstances.
Dr Sarah McLoughlin left the meeting

2.2 Update re approach to the Letter of Determination and National Service Plan 2024

EMT officials joined the meeting.

The ND Operations Planning provided an update to the Board in relation to the approach to the Letters of Determination (LoD) and the National Service Plan (NSP) 2024. The Board were advised that the final LoDs have not been received from the Department of Health or the Department of Children, Equality, Disability, Integration and Youth, and that it is intended, following discussion at tri-lateral meetings, that both Departments will issue their LoDs on the same day which will start the 21-day statutory timeline within which the HSE is required to submit the NSP to the respective Ministers. The ND Operations Planning confirmed that meetings are continuing to discuss and align Departmental and HSE thinking with a particular focus on the ongoing work and deliberations relating to 2024 service priorities, workforce numbers and financial positions. The HSE has fed back to both Departments in relation to the content likely to be included in the final LoDs, with particular note for NSP 2024 being the implementation of the Health Regions, already commenced.

The Board noted that a Joint briefing of the Audit & Risk and Planning & Performance Committees was held, to which both Committees noted draft papers presented were subject to deliberation and was not the final position of the HSE, and that all of the material was subject to further amendment.

The CFO updated the Board on the end-of-year financial position, the supplementary process, and revised Estimates, which all remain to be finalised.

The Board discussed the need to simplify the narrative for the public, and that a guide to health funding for members of the public would be welcomed, and outlined that if the HSE does not communicate effectively with the public it could undermine the entire funding approach. The CEO advised the Board that this would feature in the introduction of the NSP. The Board noted the timelines for completing the National Service Plan within 21 days of receiving the final LoD, and the key milestones and dates for delivery of the plan, including the ICT and Estates Capital Plan, the first drafts of which are being completed and engagement with the DoH and DCEDIY is ongoing.

3.1 Properties & Contracts

The Board noted the following paper as presented by the CEO.

The Audit & Risk Committee (ARC) Chair advised the Board that the ARC reviewed with the CSO and ND Capital & Estates the proposed Programme Governance Arrangements regarding the National Maternity at St Vincent’s University Hospital to ensure that effective and clear governance arrangements are in place to deliver the Programme in line with the various stages of the approvals process, and agreed to endorse Option 2, Enhanced role for the HSE as the preferred option, for recommendation to the Board. The ARC Chair advised the Board that the Committee outlined the need to strengthen risk management, further develop the assurance model, and put in place internal and external specialist resources to manage and deliver a development programme of this scale and complexity and other significant capital programmes. It was noted that the papers presented to the Board reflected the advices of ARC, to which the Board considered and approved.. Decision No.: 241123/70

The CEO presented to the Board the remaining papers which were recommended by the ARC for approval, to which the Board considered and approved.

3.2 Special Legislative Accounts

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

• 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 Board nominated the CEO and Chairperson to sign the accounts in line with signature protocols as agreed with the C&AG as set out in the paper. Decision No.: 241123/74

4.1 Audit and Risk Committee

The minutes of the Committee meeting of 13 October 2023 were noted and the Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 17 November 2023.

The Chair advised the Board that the Audit & Risk Committee and the Planning & Performance Committee held a Joint Briefing relation to the National Service Plan 2024 to which EMT officials attended.

The Chair advised the Board that the ND Operations Planning provided a summary of work completed to date on a pre-LoD version of the National Service Plan and briefly summarised the proposed timelines for completing the National Service Plan within 21 days of receiving the final Letter of Determination (LoD). The Committees noted the key milestones and dates for delivery of the plan, including the ICT and Capital Plan.

The Committee had considered the detail of proposed contracts and properties, and recommended approval to the Board.

The Chair advised the Board that the Committee received an update in relation to Primary Care Centres Operational Lease Model (OLM) and considered and approved the HSE’s recommended approach. The summary report on transactions approved between €2m & €10m and low value/nominal CAT 3a transactions for the period of 1 July - 30 September 2023, were noted by the Committee.

The Chair advised the Board that there was no paper presented to the Committee in relation to the YTD Financial Position due to the Forsa Work-to-Rule, and outlined the Committee’s industrial relations concerns.

The Committee received an update in relation to the plan for the key priorities of the HSE Corporate Procurement Plan 2022 - 2024 that are behind schedule by more than a month and an update with regard to expiring contracts and were advised of an internal review process that took place.

The Chair reported that an update was provided by the ND IA with regard to the Internal Audit Q3 2023 Report, and the Committee noted good progress being made on dealing with open audit recommendations from reports that issued between 2017 and 2021. The Committee expressed their concern about the audit ratings for Q3 which continue to remain unsatisfactory. The Committee were updated on the ND IA attendance at the Workplace Relation Commission regarding the May conciliation agreement.

The Chair advised the Board that the CEO attended part of the meeting and provided an update on the public appointment process for the recruitment of the Regional Executive Officers, the Centre Design, the NSP 2024, LoDs, the Pay and Numbers Strategy 2024, the end-of-year financial position, supplementary process, and Forsa’s Work to Rule. The CEO will attend the December meeting and provide the Committee with a further update in relation to the Centre Design.

4.2 Planning and Performance Committee

The minutes of the Committee meeting of 20 October 2023 were noted and the Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 17 November 2023.

The Chair advised the Board that the Committee received an update by the ND Communications on

the current HSE media coverage, particularly in relation to coverage since Budget 2024 and how it has differed to previous years. The Committee outlined the importance communicating positive developments to the attention of the public and staff in services.

The Committee was presented with the monthly COO Performance Report, HSE Hi-level KPI Report (previously OSR), Performance Profile (September Data), National Performance Oversight Group (NPOG) Meeting Notes.

The Committee were updated on the key strategic and operational updates with a particular focus on Scheduled Care, Urgent and Emergency Care, Urgent Colonoscopy, Cancer Services, Therapy Waiting Lists, CAMHs, Disability Services, National Screening Services, Human Resources; Pay and Numbers Profile, and Escalation under Performance and Accountability Framework (PAF) 2023.

The Committee discussed Older Persons Services, in particular the Commission on Care which is a Government initiative and will begin work in 2024, and the launch of the Roadmap for Service Improvement 2023-2026, Disability Services for Children and Young People, highlighting that the level of service user consultation was not strong enough during the development of the Roadmap and that has been reflected in the public reception.

The Committee was presented with a Focus Area Report on the National Ambulance Service (NAS), outlining the NAS Strategy to 2031 and the key strategic risks facing NAS at present, and the Committee discussed the issues in relation to NAS recruitment.

4.3 Safety and Quality Committee

The minutes of the Committee meeting of 20 October 2023 and the Quality Profile (August data) were noted. The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 16 November 2023.

The Chair briefed the Board on the monthly Chief Clinical Officer’s report which included an update with regard to the Winter Vaccination Programme; Primary Childhood Immunisation Programme; the Catch-up Vaccination Programme for Refugees and International Protection Applicants; the National Doctors Training Programme Model 3 Hospital Report; the National Doctors Training Programme Model 3 Hospital Report; the National Women and Infants Health Programme’s Obsteric Event Support Team Programme; CHI Reviews; Winter preparedness: Planned respiratory virus epidemiology and surveillance outputs from HPSC for the 2023/2024 winter season; National Screening Services; Current ED Activity at Our Lady’s Hospital Navan; and Childhood, Adolescent and Young Adult Cancers.

The Board were advised that the Committee were presented with a patient experience video outlining the challenges of dealing with a pressure ulcer and how this links to the Patient Safety Strategy. It was agreed that plans for measurement of wound care including audit of impact of guidelines and training etc. would be provided to the Committee for information.

The Committee considered the Quality Profile from the September data cycle and that there was very little change in the monthly indicators compared to August, and it was agreed that further information on the location of individual Emergency Departments would be provided going forward.

The Committee received an update from the AND Enterprise Risk Management on the Corporate Risk Review 2023, which was undertaken on recommendation of the 2021 Moody Risk Review, and presented to the Committee the HSE Q2 2023 Corporate Risk Register (CRR) Report.

The Committee noted that the Q2 2023 Corporate Risk Report – Safety and Quality Committee Risks, and discussed the risk ratings and outlined mitigation factors presented and asked that more information on risks which have had their ratings changed to be included going forward.

The Committee were provided with an overview of the programmes of work undertaken by the National Quality and Patient Safety Directorate to address the Common Causes of Harm, which included a Programme for Sepsis; Deteriorating Patient Improvement programme; Medication Safety Programme; and Improvement Programme for Wound Management.

The Committee was presented with the Q3 2023 Healthcare Audit Report which highlighted issues seen in certain sites including Use of Review Tools for Healthcare Associated Infections, Self-Harm and Suicide Related Ideation in Emergency Departments, and Assessment and Management of Postmenopausal Bleeding. The report highlighted that not all recommendations made to one voluntary hospital were accepted, and the Committee raised concern about this non-acceptance of IA recommendations as it relates to assurance, oversight and governance.

4.4 People & Culture Committee

The minutes of the Committee meeting of 25 September 2023 were noted. The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 20 November 2023.

The Chair advised the Board that the Committee were presented on the current position in relation to the Health Regions programme, an update in relation to the recruitment of the Regional Executive Officers and were advised that the 6 Regions geographies have been finalised. The Committee noted that once the HSE Centre and Health Region EMT structures have been agreed, work will mobilise with National HR in order to progress staff transition options/arrangements.

The Chair reported that the Committee were presented with the Internal Communications report which included an update in relation to the current communications activities including the Winter Vaccine campaign, the upcoming Climate action campaign, and how the new HSE Health Regions will be branded/named and the public campaign associated with the change to 6 Regions. The Committee welcomed the news that HSE Communications received an Award of Excellence at the Institute of Internal Communications with their entry Access all areas: accessible online content for HSE staff with a relentless focus on user needs.

The ND HR provided the Committee with the HR Bi Monthly report and briefed the Committee in relation to the Health Sector Workforce figures, an update on the Fórsa Industrial Action, and the Culture Programmes and Culture engagement workshops. The Committee discussed the challenges associated with integrating new staff from overseas and were advised that Diversity Equality and Inclusion (DEI) team is working on a new training course that will be available to all managers.

The Chair advised the Board that an update was received in relation to the Health Service Excellence Awards 2023, and were acknowledged for supporting and partaking in shortlisting entries. The Committee were advised that the Career Hub was awarded the Best Public HR initiative at this month’s HR Leadership and Management Awards Ceremony.

The Committee reviewed the HR Mandatory Training Dashboard, and noted that that compliance is not where it should be and suggested that a greater emphasis on improving compliance, particularly in relation to Cyber security, is required.

The Chair advised the Board that the Committee received an update in relation to the NSP 2024 and the Pay & Numbers Strategy – 2024 and were briefed on the on the current Workforce position.

The Board were advised that a discussion took place in regard to the measurement of the employment of people with a disability in the HSE and the Chair will meet with the Head of the National Disability Authority in the coming week, and will feed back to both the Committee and the Board.

5.1 Enhanced Community Care Programme

Mr Pat Healy, ND Clinical Programme Implementation and Professional Development and Ms Geraldine Crowley, AND Enhanced Community Care Programme & Primary Care Contracts were in attendance for the discussion of this item.

The Board Strategic Focus paper on Enhanced Community Care (EEC) Programme was brought to the Board for consideration.

The ND Clinical Programme Implementation and Professional Development presented to the Board an update in relation to the EEC Programme, the objective of which is to deliver levels of trusted care with service delivery reoriented towards general practice, primary care and community based services. The Board noted that the focus is on implementing an end to end care pathway that will care for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so and enable a “home first” approach.

The Board were updated in relation to the significant progress regarding the completion of the model and the establishment in 2023 of Community Healthcare Networks (CHNs), Community Specialist Teams (CSTs) for Older people, Community Specialist Teams for Chronic Disease, national coverage for Community Intervention Teams and the development of a volunteer-type model in collaboration with ALONE. As the operationalisation of teams has progressed towards completion, the Board outlined that it is critical that the ECC model is embedded across all locations, with a focus on the delivery of the full end to end pathway and ensuring integrated team working across the full continuum of care.

The ND Clinical Programme Implementation outlined the key enablers of the ECC which are the ECC Healthlink, Area Finder, the ECC Conference which took place in September 2023, the EEC Capital Plan which saw 34 permanent hubs across 34 locations, and the approved allocation of €263m on full roll out.

In relation to the 2024 opportunities and challenges, the Board noted that given the developments in recruitment and funding for 2024, the focus of the continued implementation of the ECC Programme in 2024 will be on consolidating productivity and performance. This will be accomplished by supporting the current teams in achieving maturity levels, maximising their impact and productivity, and flexing its model where possible in order to maximise its reach. It was noted that it will be crucial to fully realise the potential of the teams currently in place and maximise the positive impact that the Programme has on supporting the UEC Plan, including reducing OPD waiting lists, reducing ED attendance, improving hospital avoidance, supporting early discharge and bring care closer to home, and the Programme will continue to play a key role in supporting these priorities.

The Board thanked the ND Clinical Programme Implementation & Professional Development and the AND Enhanced Community Care Programme & Primary Care Contracts for their update and welcomed the progress to date. It was agreed that an update would be brought to the Board twice yearly on the progress of the EEC programme.

ND Clinical Programme Implementation & Professional Development and the AND Enhanced Community Care Programme & Primary Care Contracts left the meeting

There was no further business. The meeting concluded at 13.05pm. It was noted that the next meeting would take place in the Boardroom, Dr Steevens’ Hospital on 15 December 2023, and that there will be a Special HSE Board meeting to approve the National Service Plan 2024, date to be advised to the Board.