HSE board meeting minutes 25 November 2022

A meeting of the Board of the Health Service Executive was held on Friday 25 November 2022 at 9:00am.

Present:

Mr Ciarán Devane (Chairperson), Prof Deirdre Madden, 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

In Attendance for Board Meeting:

Mr Stephen Mulvany (Interim CEO), Dr Colm Henry (CCO), Ms Mairead Dolan (Interim CFO), Mr Dean Sullivan (CSO) Mr Fran Thompson (CIO), Mr Tom Malone (ND IA), Mr Damien McCallion (COO), Mr Mark Brennock (ND Communications), Ms Eileen Whelan (ND T&T), Mr John Ward (CTTO), Mr Brian Murphy, Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew

Joined the meeting:

Dr Philip Crowley (ND Strategy & Research), Mr Paul de Freine (ND Capital & Estates), Mr Mark Kane (AND C&E), Mr Robert Morton (Director NAS)

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.

1.2 Declarations of Interest

No conflicts of interest were declared.

1.3 Chairperson’s Remarks

The Chairperson provided an update to the Board during their private session.

1.4 Correspondence

The Board noted correspondence received relating to:

• Reconfiguration of Services at Our Lady’s Hospital Navan (OLHN)
• National Service Plan 2023
• Owenacurra
• Irish Nurses and Midwives Organisation (INMO)

1.5 Minutes of Board meeting

The Board approved the following minutes.

• 05 October 2022 – Special Board Meeting re Reconfiguration of Services at OLHN
• 06 October 2022 - Meeting with Minister for Health & HSE Board re Waiting Lists - 26 October 2022 – Board Meeting
• 10 November 2022 – Special Board Meeting re National Service Plan 2023

2.1 Audit and Risk Committee

The minutes of the Committee meeting of 13 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 10 November 2022. He advised the Board that the Q3 2022 Corporate Risk Register (CRR) report will be presented to the Board at its December meeting, and from 2023 onwards the Q4 CRR will be considered by the Board in March of the following year which will align with the Annual Report cycle. The stakeholder engagement concerning the draft Enterprise Risk Management Policy was welcomed by the Committee and the review of the Risk Appetite Statement would be concluded in Q1 2023 in parallel with the revision of the Risk Policy.

He advised that a brief was received on the risk of fuel shortages and power outages this winter, and a planning sub-group of the National Crisis Management Team has been established to monitor potential risks.

He advised the Board that updates were given in relation to the HSE Records Retention Policy Revision 2022, and the policy and implementation plan is to be brought back to the Committee at their next meeting. He referred to discussions concerning the Memorandum of Understanding with the Charities Regulator, and the reference to the ARC in the MOU communicating with the Charities Regulator is being amended and a plan for Section 38 & 39 agencies will be brought to the next meeting of the Committee.

The Chair advised the Board in relation to the update on the progress on settling reporting requirements to DoH and DPER, and the SIC Process for 2022 on Procurement Compliance Assessment for Q1 & Q2 returns for 2022 which the CFO has undertaken to follow up and present at the next Committee meeting.

The Committee were presented with two Strategies; Climate Strategy and Implementation Plan, and the capital commitments of the National Ambulance Service (NAS) Strategy which he noted would be discussed later in the meeting.

The Committee received a number of briefings under Internal Audit, and was presented with Q3 IA Reports, where the Committee outlined their concern in relation to the findings of Q3-22-ASD-002: Children First Legislation - Galway University Hospital (GUH) and the Monitoring Probation controls report which is to be brought to the People & Culture Committee. A briefing concerning IA Report – Risk Management and an update on the Internal Audit’s Review of funded agencies audit approach was received by the Committee.

The Chair advised that the COO and EMT members attended the Committee meeting to present a detailed report on the updated position in respect of 2020 and 2021 IA O/S Recommendations; and the Management Action Plan concerning the High Earners Review Consultants IA Report, outlining reasons for timeline slippage in the Action Plan and assurance was given that this work will be completed in line with the revised timelines and further updates will be received in the first quarter of 2023.

2.2 People & Culture Committee

The Chairperson of the Committee informed the Board that the People and Culture Committee have not met since the last Board meeting. The next meeting will take place on the 02 December 2022 and that the Committee would be reviewing a recruitment heat map which will highlight performance against the minimum and maximum target per division. The Chair also informed the Board that the ND HR will be bringing a Resourcing Strategy to the Committee in January 2023.

2.3 Performance and Delivery Committee

The minutes of the Committee meeting of 23 September 2022, 02 & 08 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 18 November 2022 and informed the Board that the recruitment of new members to the Committee is currently underway. He noted that the Committee were provided with a presentation on the proposed National Ambulance Strategy, which will be discussed later in the meeting.

The issue of assaults on nursing and healthcare staff were discussed by the Committee. The Chairperson informed the Board that a paper on this will be brought to the Committee for further discussion.

The Committee discussed the possibility of adding a “HSE in the news” item to the Committee’s agenda, to ensure that they are aware of any major ongoing or recent controversies. The Chair has agreed with ND Communications that the Committee will start that process in the New Year.

The Committee had noted the growing challenges of care and support for older people in the community. He advised that he met the COO, who is working on a paper and presentation on a wider approach to the challenges older people face and the role of organisations outside the HSE in tackling these challenges, and will present the paper to the Committee, and the Board, in the New Year.

2.4 Safety & Quality Committee

The minutes of the Committee meeting of 11 October 2022 and November 2022 Quality Profile were noted. The Chairperson of the Committee provided a verbal report on the matters considered at the Committee meeting that took place on 15 November 2022.

The Chairperson of the Committee advised the Board that the Committee received an update on the National Ambulance Service from the perspective of a paramedic and discussed patient safety issues for the National Ambulance Service. She advised that the Committee also received an update on “NAS Pathfinder”, one of the alternative care pathways devised to divert as many people as possible away from Emergency Departments. A discussion was had about recruitment and retention issues and the COO advised that they are looking at how Registered General Nurses can be used to support this.

The Chair advised that ND Strategy & Research provided the Committee with an update on the “HSE National Consent for Research in Health and Social Policy”, outlining both the development and implementation phases.

The Chair advised that the Quality Profile had been presented in its new format and the COO and ND Acute Operations have been invited to attend the next meeting to discuss areas within the Quality Profile and to provide updates on the implementation plans on a number of Audit Recommendations.

The Chair advised that the Committee were updated via the CCO Report on Winter Viruses, Monkey Pox, the National Screening Service, OEST Progress Report, the National Stroke Strategy, and the National Cancer Care Programme. She advised that they also received position papers on the current epidemiology of Carbapenemase Producing Enterobacterales, organisms and an update on the National Strategy for Genetics & Genomics and was presented with the Q3 2022 Corporate Risk Register (CRR) Report by the CRO.

2.5 Technology and Transformation Committee

The Chairperson of the Technology and Transformation Committee informed the Board that there has been no Committee meeting since the last Board meeting, however, a workshop will be held on Monday 28th November 2022 to discuss the eHealth portfolio status 2022 and eHealth Portfolio updates for 2023.

The Chair informed the Board that while the Committee has transformation oversight, it is at the discretion of the Board, which Committee looks at certain transformation issues. He informed the Board that as they look at the specific role and structure of the Committee, they will look at how they view transformation. The Board agreed that the Chair should liaise back with the Board on this matter, noting that the Terms of Reference of the Committee have yet to be fully finalised.

Appointment of External Member The Chair of the Committee provided a briefing note and requested that the Board approve the appointment of Mr Derick Mitchell as an external member of the Technology and Transformation Committee for a period of three years until 2025. Board Decision No: 251122/96.

The Board expressed their condolences on the death of Ms Vicky Phelan.

The CEO informed the Board that Ms Gráinne Cunningham-O’Brien has now been appointed to the role of Confidential Recipient and Mr Joseph Duggan has been appointed National Director Internal Audit.

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

The Board discussed the following strategic areas of the CEO report:

Winter Viruses

The CEO advised the Board that this winter there are three main viruses: Respiratory Syncytial Virus (RSV), Influenza and COVID-19 in circulation, and due to the relatively mild weather to date, this has mitigated against transmission, but should be aware of expected spikes of cases with consequent health system pressures should there be a protracted period of cold weather.

Monkeypox

The Board were informed that the booking portal went live on 24th November with 70% of bookings received. Intra-dermal training of nurse vaccinators across Central Vaccination Centres are now complete and training has commenced this week.

National Screening Service

The Board welcomed the publication of Dr Gabriel Scally’s final report on the 23 November 2022, noting that the report confirms that women can have confidence in Irelands cervical screening programme. The Board held a discussion on the implementation of the recommendations of the Scally Report, the importance of meaningful patient and stakeholder involvement and transparent reporting structures within the National Screening Services.

Patient Safety Bill

The Chair and Deputy Chair informed the Board of the meeting that was held with the Minister for Health on 17 November 2022 regarding the Patient Safety Bill and the Board’s concerns with the intention to introduce a notifiable incident directly relating to cancer screening services, noting that this proposal might impact the screening programmes resulting in difficulties resourcing the programmes, reduced effectiveness and poorer clinical outcomes. The CEO advised that there is ongoing engagement with the DoH in relation to this.

National Strategy for Accelerating Genetic & Genomic Medicine in Ireland

The Board welcomed this much needed Strategy that is filling a long term policy gap, which had been circulated prior to the meeting. The Strategy which is due to be launched on the 13 December outlines the approach for developing sustainable patient and family centred genetics and genomics service that can be accessed equitably across the country and across the lifespan of patients. The service will be supported by strong governance, a skilled workforce, pioneering research and innovation, and trusted partnerships. The Board discussed the Strategy stating that good and transparent data governance is essential and that it will bring change that will require change management, including during the RHA development. The Board outlined that there is genetics and genomics medicine and research ongoing outside of the HSE that will need to be engaged with, including private healthcare providers and non-profit organisations. The Board noted that PPI element of the strategy was very welcome and the presenters agreed to obtain feedback from the patient representatives on their experiences of the development process that would inform the patient/service user involvement in the next steps of implementation.

The Board noted that the Safety and Quality Committee will be updated regularly on progress.

Test & Trace

The CEO advised the Board that the Test and Trace function continues to prepare for the transition to the future clinical, public health and surveillance led model, and are engaging with the DoH to ensure that appropriate planning and stakeholder engagement is in place before commencing the transition. Advice has been received from the DoH concerning expired vaccines, and continued action is being taken in relation to vaccinations of healthcare workers.

Ukrainian Update

The CEO informed the Board that the Department of Children, Equality, Disability, Integration and Youth (DCEDIY), in conjunction with Central Statistics Office, are developing a standardised set of arrival scenarios for use by all Government departments in 2023. These have not been available to inform planning assumptions for Health in 2023, however, it has been confirmed that arrival scenarios in use by HSE align broadly with those of DCEDIY. The design of the future service delivery model for Ukrainian and International Protection Applicants (IPA) populations is nearing completion. The model seeks to enable the same access to services as is available to the existing population whilst addressing the specific health needs of both populations

Disability Services

The Progressing Disability Services Roadmap is currently being developed which will set out the actions being progressed by the HSE to improve services for children with disabilities and developmental delays as well as their families. This process is concluding, and a draft roadmap will be presented to the Performance and Delivery Committee in December for consideration with the aim to complete the development of the plan before the end of 2022.

National Ambulance Service (NAS) Strategy

The CEO presented to the Board the NAS 10 year Strategy (2021-2031), which sets out the vision and objectives for the future of the National Ambulance Service (NAS). This is aligned to the HSE Corporate Strategy, which can inform future investment decisions and which sets up NAS as a potent enabler of the Slaintecare vision to treat more people closer to home. The Strategy has been reviewed by the Audit and Risk Committee on 09 November 2022 and supported by the Performance and Delivery Committee on 18 November 2022. The CEO advised that DoH have indicated that the Minister is bringing a Memorandum to Government seeking support for a programme of investment in NAS over the coming years, based on this strategy. The Board welcomed the development of the strategy and noted that it will be submitted to the Minister for Health.

Waiting Lists

The Board considered the report provided on the implementation of the 2022 Waiting List Action Plan which had set an ambitious improvement in waiting lists and waiting times. The Board noted that, overall, progress against targets has been slower than projected and as a result, the total number of patients on the outpatient waiting list is 14% behind target and the total number of patients waiting on the inpatient / day case waiting list is 6% behind target. The Board noted the progress made in relation to reducing the number of patients waiting longer than the 2022 maximum wait time targets set.

The CEO and COO confirmed ongoing engagement with the delivery system has identified a number of contributing factors, including the continued impact of COVID-19 and ED pressures, bed capacity, increased staff absences and capacity deficits within a number of specialties (e.g. Orthopaedics, ENT, Rheumatology, etc.). In the last 13 weeks, however, core activity volumes have been ahead of target and improvements in both the total number of people waiting for care and the number of people waiting longer than the maximum wait time targets have been achieved.

The COO informed the Board of a number of remedial actions that are being progressed, including the establishment of an Acute Operations Oversight Group chaired by the National Director of Acute Operations and weekly performance meetings with Hospital Groups. Additional administrative resources have also been provided to increase HSE’s capacity for NTPF commissioning and validation, with 10 additional sites commencing validation for patients waiting longer than three months.

The COO noted that while we are seeing progress in many individual hospitals in increasing activity, and thereby in reducing waiting lists, our challenge is now to replicate these success stories across the health system.

The Board welcomed the recent additional actions that the CEO and the executive had put in place to improve the current situation and requested management to make a concerted effort to enable progress on waiting lists to year end, albeit recognising that for a number of reasons, including the higher than anticipated impact of COVID, it would not be practical to fully achieve the targets by year end.

Reconfiguration of Services at Our Lady’s Hospital Navan (OLHN)

The Board discussed the correspondence received from the Minister for Health dated 24th November 2022 and confirmations received from the Secretary General to the CEO, noting that the DoH is satisfied with the HSE’s proposal to proceed with the enhanced bypass protocol for OLHN to include those who are critically or seriously unwell or likely to deteriorate, from the week of 12 December 2022.

It was noted that this is on the basis of the clarifications on the bypass protocol previously provided by the HSE and conditional on shared clinical governance/repatriation arrangements being agreed in advance with both hospitals.

The CEO informed the Board that an implementation group, led by ND Acutes, Mary Day and Dr Mike O’Connor, are continuing to oversee the implementation of the bypass protocol.

A response to the recent correspondence from the Minister, regarding progression of the review’s recommendations, will be prepared.

Climate Action Strategy and Implementation Plan

The Climate Action Strategy and Implementation Plan, which had been circulated prior to the meeting was welcomed by the Board noting that it had been considered and supported by the Audit & Risk Committee. The Board were informed that the Plan is an essential enabler to providing resilient healthcare infrastructure to support current and future service needs, therefore both supporting the objectives of Sláintecare and helping to build public trust amidst a rapidly changing climate and environment.

The Board welcomed the development of the Climate Action Strategy and Implementation Plan. The next steps for the Strategy’s implementation include the establishing of a Programme Management Office and allocating the resources to mobilise implementation, appointing Workstream Leads and members and communicating their roles, responsibilities and Workstream deliverables and to identify Subject Matter Experts and appropriate external support to assist the Workstreams and Steering Group.

Capital Strategy and Implementation Plan

The CSO presented the Capital Strategy and Implementation Plan proposal, which had been considered and supported by the Audit & Risk Committee. The Strategy sets the direction for the future development and management of Healthcare estate. The associated Implementation Plan sets out the key details for the successful implementation of the Strategy, allowing the HSE Capital and Estates team to establish the Programme and progress to implementation as soon as possible.

The Board welcomed the Strategy and Implementation Plan.

In relation to a request from the Board, the ND Estates agreed to circulate a list of derelict properties to the Board.

Board Strategic Scorecard

The CEO presented the Board Strategic Scorecard, as circulated prior to the meeting and the Board discussed the ratings in relation to key programmes and priorities. It was noted that the overall average rating on the eligible 20 scorecards is 2.65, down from the October 2022 rating of 2.75 due to a change of rating returned on two scorecards. These were Reform of Primary Care, Community and ECC changed from a 3 to a 2 and Planning and Implementation of Regional Health Areas changed from a 3 to a 2. All other scorecard ratings have remained constant.

Following the discussion, the Board approved the Board Strategic Scorecard for submission to the Minister.

4.1 Property Transactions

The Board approved the following property transactions.

Property Transactions

1. Lease of newly constructed Palliative Care Hospice Co Roscommon and subsequent sublease of one room within the building back to Mayo Roscommon Hospice. Decision No.: 251122/83
2. Proposed Lease of Primary Care Centre, Fethard, Co. Tipperary. Decision No.: 251122/84
3. Proposed Lease of Primary Care Centre, Tullow, Co Carlow. Decision No.: 251122/85
4. Proposed Lease of Primary Care Centre, Urlingford, Co. Kilkenny. Decision No.: 251122/86
5. Proposed acquisition of a building, Dublin 1. Decision No.: 251122/87
6. Proposed Lease of Primary Care Centre, Bishopstown, Cork. Decision No.: 251122/88
7. Proposed Lease of Primary Care Centre, Douglas, Cork. Decision No.: 251122/89
8. Proposed Lease of Primary Care Centre, Cavan. Decision No.: 251122/90
9. Proposed Lease of a floor, Letterkenny, Co. Donegal Decision No.: 251122/91
10. Proposed lease of a unit, Co Kilkenny, for Finance Shared Services - National Finance Division Decision No.: 251122/92
11. Proposed Lease of a unit, Santry, Dublin 11 Decision No.: 251122/93

4.2 Contract Approvals

The Board approved the following contracts;

1. Proposed Award of Contract – Respiratory Assessment Unit, Midland Regional Hospital, Portlaoise. Decision No.: 251122/94
2. Banking Transition Programme – Bank Account Opening – Wave 2 & 3 Decision No.: 251122/95
   - Approval to Open Bank Accounts The opening of 26 bank accounts which are in scope for Wave 2 (14 bank accounts – go-live of 1st February 2023) & Wave 3 (12 bank accounts - go-live of 1st March 2023)
   - Approval of the Designated Signatories

5.1 Review of the Board Strategic Scorecard

The CSO presented to the Board the work being done to review the continued effectiveness of the Board Strategic Scorecard (Scorecard) in terms of its developments to date and potential improvements for 2023. The briefing to the Board covered the background to the development of the Scorecard. It noted that the purpose of the Scorecard is to enable the Board to work collaboratively with the CEO and EMT to identify a number of key strategic programmes and priorities to be delivered during the year for inclusion in the Scorecard, to ensure the effective tracking progress of delivering these key priorities, to review and flag concerns that may impact the delivery of key programmes and priorities, and to minimise multiple requests and duplication of effort in collating reports for Board and Department of Health. The development and refinement of the Scorecard, since it was introduced in 2021, was also covered.

The Board considered in the context of Performance Management and Reporting requirements for 2023, the future development of the Scorecard to ensure there is appropriate reporting on priorities and programmes which would guide and support Board discussions each month, in particular in relation to performance issues and remediations that may be required.

The Board reviewed the continued effectiveness of the Scorecard in a number of key areas for improvement. This included how the Scorecard content and format might be improved to enable a focus on more strategic deliverables and KPIs and better reflect the priorities and programme commitments outlined in the HSE Corporate Plan 2021-2024, the National Service Plan, the Ministerial Priorities in the Letter of Determination and Sláintecare action plans, and explore links to the National Performance Oversight Group and other corporate reports. The Board also considered how the Scorecard might be improved as an engagement and communications mechanism (wider system internally and externally-public facing), and whether the process for consideration of the Scorecard by EMT and the Board is effective.

A discussion was had about the targets for the Scorecard and it was observed that achievement of targets should bring about measurable improvements, and where the ratings change the reasons for the improvement/disimprovement should be highlighted. The Scorecard should be a key driver of issues for Board consideration rather than simply a narrative in the CEO Report. The CSO advised that the outline 2023 Scorecard will be discussed at the January Board Meeting.

Board members also suggested that scores/ratings need to be reviewed more effectively at an earlier point in the year to highlight performance issue and allow more timely mitigation.

The CSO thanked the Board for the helpful inputs and feedback and it was agreed that a subgroup of the Board would be established to continue Board input into the review of the Scorecard with the CSO. Board members that are available to participate on the Board group were asked to inform the CSO/ Corporate Secretary.

It was agreed that this will be brought back to the Board January meeting.

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 in person in Dr Steevens’ Hospital.

The meeting concluded at 3.30pm.