HSE board meeting minutes 26 April 2023

A meeting of the Board of the Health Service Executive was held on Wednesday 26 April 2023 at 9:00am in the Boardroom, Dr Steevens’ Hospital.

Present:

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

In Attendance for Board Meeting:

Mr Bernard Gloster (CEO), Mr Stephen Mulvany (CFO), Ms Anne Marie Hoey (ND HR), Mr Mark Brennock (ND Communications), Mr Fran Thompson (CIO), Mr Brian Murphy (Head of Corporate Affairs), Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Office of the Board).

Joined the meeting:

Dr Philip Crowley (ND Strategy and Research), Ms Miin Alikhan (AND Strategy and Research), Mr Peter Smyth (AND Capital & Estates)

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 Chairperson welcomed Board members to the meeting and held a private session to consider the agenda and papers for the meeting.

1.1 Declarations of Interest

No conflicts of interest were declared.

1.2 Chairperson’s Remarks

The Chairperson provided an update to the Board during their private session. The Board noted the appointment of Mr Brendan Whelan as the new Chair of the Audit and Risk Committee. The Chair informed the Board that he is due to hold the HSE / DoH Quarterly Meeting with the Minister for Health on 15 May 2023.

1.3 Correspondence

The Board noted correspondence received relating to: Ministerial Correspondence - Chair to Minister for Health re HSE Financial Reports dated 31 March 2023 - Minister for Health to Chair re 2023 Revised Approved Level of Expenditure dated 06 April 2023 - Chair to Minister for Children, Equality, Disability, Integration and Youth DIY re Transfer of functions of Specialist Community Based Disability Services from Department of Health to the Department of Children, Equality, Disability, Integration and Youth dated 06 April 2023.

1.4 Minutes of Board meeting

The Board approved the minutes of 31 March 2023.

2.1 CEO Report

The Board reviewed and discussed the key aspects of the CEO monthly report. The Board noted that this was the first report in the new format of the new current CEO and welcomed the approach. The Board made suggestions in relation to the new format, proposing that the order of contents should focus in order on priorities/strategic objectives, significant issues for note, Board related matters and CEO engagements. The Board also suggested that the report addresses key performance issues linked to the Board Strategic Scorecard.

The CEO reported on recent activity under the headings of access to care and urgent care and significant items of note since the last Board meeting;

Waiting List Action Plan (WLAP)

The CEO noted that an extensive Waiting List Action Plan (WLAP) for 2023 is underway as part of a multi annual approach to waiting lists for key services. This is a Department approved plan with specific oversight and engagement between Department officials and executive senior managers connected to a further process of oversight by the Minister for Health, Secretary General and CEO.

The Board were informed that while access across the organisation in all of its functions remains a challenge and key focus, the WLAP targets specific services in the hospital and to a smaller degree in the community space. In respect of the main part of the plan the CEO noted that he has now reorganised national resources to point to a single line of planning and accountability.

The Board welcomed that performance against the plan at the end of March 2023 is positive and noted that some challenges remain. The CEO informed the Board that the challenges could be grouped under three specific headings of new additions, performance against plan and additional WLAP activity. It was noted, however, that significant traction has been gained in recent weeks. The Board discussed the challenges, noting that the core to understanding performance of ‘WLAP and Access’ is the length of time people are waiting and plans to address them, including long term reforms to modernisation patient care path ways to deliver sustained meaningful reductions in waiting lists.

The Board also discussed the progress of the enhanced Community Care Program in particular the development of Community Health Care Networks which will provide for the integration of General Practice with wider community services allowing for more local decision making and improving access to primary care services.

Urgent care

The Board were informed that services continue to be challenged in respect of urgent care and that sustained focus over recent weekends was required in order to maintain a manageable position. The CEO noted that on April 20th, the trolley waiting position 363 was at 20% higher than the same day in 2022 and that, while focus on delayed transfer of care is starting to show improvement in recent weeks, it cannot be relied on as a sustainable improvement until further performance and actions are assessed. The CEO briefed the Board on the After-Action Review of Winter 2022 which was shared with the Board prior to the meeting. The Board noted that it sets good context and analysis of performance for the period, but that building Capacity will remain challenging and the only short-term improvement space is in both process and culture. The Board welcomed that the organisation focus for the balance of 2023 will remain on capacity management and for 2024 a full year-round plan as distinct from a Winter Plan will be required. It was agreed that there would be early engagement with the Performance and Planning Committee on progress and development and on the longer term recommendations to be considered as part of the development of the 3-year Unscheduled Care plan.

Organisation Change

The CEO also reported and provided an update to the Board on three key activities under in relation to organisational change:

• Establishment and first engagement with the new interim Senior Leadership Team
• The RHA draft documentation previously viewed by the Board which has now received Ministerial input and feedback. The CEO also noted that all resource and activity on RHA development and Centre design to one single point of accountability are now directly within the scope of his office.
• Ongoing work with the Technology and Transformation Committee regarding the framework for understanding and managing all change activity. The Board noted that the outcome of this work will be considered at the May Board meeting.

HR position

It was noted that the HR position remains as last notified, with good outturn on recruitment but that significant work is yet to be advanced in both resourcing and the overall approach to a People Strategy Performance.

Significant issues for noting

The CEO advised the Board on the following service-related issues for noting at this time, given recent or pending attention to them:

• Progressing Disability Services and Assessment of Need Disability
• Termination Services Review – recommendations from report to be circulated to Board
• Paediatric Palliative Care
• Clinical Focus
• Public Accounts Committee
• Capital Plan revised – proposed changes to be circulated for Board approval.

2.2 Financial Matters

The CFO was in attendance for the discussion of this item. The Board noted the 2023 Revised Approved Level of Expenditure (Letter of Determination) dated 06 April 2023, and the two specific financial concerns which related to the level of emerging expenditure trajectory, specifically in relation to the COVID Acute and Community responses particularly with regard to the unfunded and once-off only funding nature of expenditure, and the already evident expenditure pressures within the hospital system. The Board continued to highlight their concern in relation to the overall level of financial issues and risks, outlined in the National Service Plan of up to 10.2% (or €2.2bn) that may arise in 2023.

The CFO outlined to the Board the four spend categories to which the HSE will experience financial issues and risks during 2023. He advised that the DOH have indicated that, in their view, the HSE figures overstate the level of financial issues and risks, but that the DOH and HSE are fully aligned on the need for any mitigation measures relating to addressing the financial issues and risks will not impact negatively on planned service capacity, activity or access.

The Board were advised in relation to the approach and key principles of the Financial Framework which are: to provide services with realistic budgets, to report and monitor any deviation in deficits arising under the relevant spend categories and the mitigation actions and expenditure management programme that are in place, and will be updated as necessary in light of experience and engagement as the year progresses.

The Board discussed the financial position at the end of February 2023, noting the overall core deficit of €126.9m, with acute operations represented as 165% of the total YTD Feb deficit and COVID – 19 at 69%.

They noted that in advance of the availability of the preliminary 2023 Financial Outlook based on Q1 results, initial indications are an I&E 2023 deficit in the region of circa €1.6b with a cash shortfall of circa €1.1b, which compares to the €2.2b (10.2%) flagged in the National Service Plan 2023. The CFO advised the Board that this assessment is heavily caveated and can only be used as an initial indicator of potential in expenditure for 2023. The CEO advised the Board that the financial information will be better informed when the Q1 figures are finalised, and will be brought to the Board at their meeting in May 2023.

The CFO advised the Board that ongoing engagement with external stakeholders including the DoH, via the Health Budget Oversight Group process, is continuing, and that critical focus in the challenging financial position remains.

The Board recognised the impact that the financial challenge will have on available resources and delivery of services, and highlighted that the HSE will need to work collectively with significant monitoring and engagement through internal governance structures, most notably through the EMT, Audit and Risk Committee and the Board.

2.3 Board Strategic Scorecard 2023

The CSO, CFO, COO, CCO, ND HR were in attendance for the discussion of this item. The CEO presented the April Board Strategic Scorecard (BSS) 2023 for the March reporting period, as circulated prior to the meeting. The Board noted that due to the timing of the Board meetings, the absence of comprehensive integrated information systems and other factors, it is not possible for the CEO to present the BSS to the Board in a manner consistent with the timelines for the submission of Board papers, therefore the BSS is presented to the Board with 62% of KPI’s profiled.

The Board and CEO discussed various ways that the BSS could be presented to ensure that an adequate and complete review is possible.

It was agreed that, going forward, the BSS will be presented to the Board two months in arrears, with the March reporting period being presented at the May Board meeting, to ensure that all of the information necessary for the completed BSS is included. The Board requested that if there are any issues with the more present data, that the CEO will advise the Board in his CEO Report.

The Board also agreed that a more detailed consideration of the BSS would be reviewed by the Board each quarter.

It was agreed to defer the approval of the BSS presented at today’s Board meeting, and that the CSO would forward a copy of the BSS to the Department of Health.

3.1 HSE Annual Report 2022

The CFO, COO, CCO, ND HR were in attendance for the discussion of this item.

The ND Strategy and Research presented to the Board for consideration and approval the final draft of the HSE Annual Report 2022, which had been recommended by the EMT and presented and endorsed by the Planning & Performance Committee at their meeting on 25 April 2023.

The Chair of the Planning & Performance Committee advised the Board of the Committee’s review of the final draft of the HSE Annual Report 2022 that it was agreed that an in depth discussion will take place early in 2024 before the process for the Annual Report 2023 begins.

Board members adopted the HSE Annual Report 2022, and noted that it may be subject to required editorial amendments during the design and layout process. Board Decision No.: 260423/27

3.2 IFMS Post Go - Live Support (PGLS) contract

The CFO was in attendance for the discussion of this item. The CFO presented the IFMS Post Go Live Support (PGLS) Contract to seek approval from the Board on the recommendation from the Finance Reform Programme Governance and the HSE Audit and Risk Committee / Technology and Transformation Committee to approve the Change Control Note (CCN) in respect of IFMS Post Go-Live Support under the System Integrator contract for the Integrated Financial Management System (IFMS) for the Health Service. He advised the Board that the CCN must be approved by the Board as it commits the HSE to a contract whose value exceeds €10m.

The Chairman of the Audit & Risk Committee advised the Board that he had circulated the PGLS Contract to Committee members, and subsequently received approval from Committee members by email, as there was no meeting of the Committee held in April.

The Board reviewed the paper presented and agreed to approve the IFMS Post Go Live Support (PGLS) Contract. Board Decision No.: 260423/28

4.1 Planning and Performance Committee

The minutes of the Committee meeting of 22 March 2023 were noted and the Committee Chairman provided a verbal report on the matters considered at the Committee meeting that took place on 21 April and 25 April 2023.

The Chair advised the Board at the Committee’s meeting of 21 April 2023 that a discussion was held concerning older people living at home who depend on the HSE for support, and that the contracts that are in place to provide homecare support, many of them with the private sector, are near expiry date and that a tender process has been initiated to renew the contracts.

The Committee noted an update received with regard to waiting lists for a wide range of treatments and were advised that a detailed study is underway into possible causes, such as demand after COVID and changing demographics. It was agreed that an update will be brought to the Board at a future meeting.

The Committee were provided with a presentation with regard to General Practice, and noted comparisons between the number of GPs in Ireland and other countries. The Board discussed the significant investment in GP support.

The Committee Chair advised the Board that work is continuing on the development of a three-year plan to address deficiencies in emergency care, and it is aimed to be presented to the Board in June and submitted to Government in time for the Estimates campaign.

The Committee received updates in relation to Risk Management and also from the Social Inclusion Office and were advised of further progress in respect of Progressing Disability Services, which will return to the Board in the coming months.

The Committee Chair advised the Board of the Special Committee meeting that took place on 25 April 2023 to review the final draft of the HSE Annual Report 2022 before its submission to the Board.

Reappointment of External Member

The Chair of the Committee requested that the Board approve the reappointment of Dr Sarah Barry as an external member of the Planning and Performance Committee for a further term of 2 years until 27 February 2025, which the Board approved. Board Decision No.: 260423/26

4.2 Safety & Quality Committee

The minutes of the Committee meeting of 24 March 2023 and the January Quality Profile were noted. Board member Anne Carrigy provided a verbal report on the matters considered at the Committee meeting that took place on 25 April 2023.

The Committee were presented with an update on the work of the National Rehabilitation Hospital and viewed a Patient/Staff Experience on the theme of disability regarding two patients with spinal cord injury. The Committee were also provided with an update in relation to Adult Safeguarding, and welcomed that an increase to the workforce has been sought and approved. A discussion was held on the current activity and the progress and challenges in safeguarding operations and the need to identify opportunities for and risks during the Regional Health Areas implementation.

The Committee considered the Quality Profile from the February data cycle. The Committee welcomed the new Confidential Recipient, Ms Gráinne Cunningham O’Brien, who outlined her role in terms of advocacy, empowerment and listening and the Committee welcomed her plans to draft up a more user focussed protocol.

The Committee received a briefing on a range of learnings made from high court judgements, and welcomed that as a result, an After Action Review of relevant individual cases and an aggregate report, is being produced to inform the immediate areas of focus for improvement to avert cases reaching crisis point.

The Committee were presented with the findings of HIQA’s 2021 Disability Overview Report by the Chief Inspector, Deputy Chief Inspector, and Interim National Operations Manager for Disabilities of HIQA, and also discussed the status of the forthcoming home support legislation, the findings of planned inspections versus unplanned inspections and the expanding role of home support.

4.5 Technology and Transformation Committee

The Committee Chair advised the Board that there was no formal meeting of the Committee in March, but provided a briefing to the Board with regard to the Technology & Transformation workshop which took place on 13 April 2023.

He advised the Board that the objectives of the Workshop were to identify and understand the key requirements for a structured prioritisation framework and process for operational and transformation programmes, and also to identify the key criteria to be used in a HSE prioritisation framework, and the monitoring and reporting requirements for HSE Board and EMT for operational and transformation programmes.

5.1 Climate & Sustainability - Plans to achieve Net Zero

The National Director of Strategy and Research and the AND Capital & Estates were in attendance for the discussion of this item.

The Board Strategic Focus paper on Climate & Sustainability – Plans to achieve Net Zero was brought to the Board for consideration. A paper on “Climate & Sustainability – Plans to Achieve Net Zero” was presented and it was noted that the HSE, as a Public Sector Body, has a key role to play in tackling the climate crisis by further developing options to curb its own emissions and understanding the link between environmental pollution and disease, and environmental quality with population health.

The Board discussed the Government’s key targets for reducing emissions and the AND Capital and Estates introduced the HSE’s Infrastructure Decarbonisation Roadmap, which sets out the approach and a detailed set of actions to achieve the Scope 1 and Scope 2 emissions targets to 2030 and 2050 that are set out in the Governments Climate Action Plan. It was explained that the HSE’s Climate Action Strategy (2022 – 2050) responds to and outlines a broader approach to the actions and targets set out in the Climate Action Plan, looking at non-energy and built environment related emissions and environmental harms that we can influence such as: Procurement, Green Spaces, Transport and Mobility, Water and Waste Management, Adaptation and Resilience and Greener Models of Healthcare delivery.

An update on the HSE’s progress to date was presented and clear actions that the HSE will progress for greener models of care, adaptation & resilience, an enhanced HSE Green Environment and ensuring sustainable procurement. The HSE Infrastructure Decarbonisation Roadmap, which deals with achieving energy and build environment targets was presented and outlined individual goals achieved by the Roadmap to date and the key issues that have been encountered during the implementation of the Roadmap.

The Assurance Process of the Board and the Key Performance Indicators / targets of the Strategy were outlined and the implications for other strategic priorities / Service Plan were explained and the approach that will be taken to Stakeholder Management was also outlined.

The Board held a discussion on the healthcare sector’s likely contribution to global greenhouse gas emissions and it was explained that the Programme reports into the Audit and Risk Committee due to the large amount of estates in the management of the HSE. It was agreed that the Government’s aim of achieving net-zero greenhouse gas emissions no later than 2050 should be more ambitious and that as targets are related to energy-related emissions, that this is the initial focus, based on International advice and reports. The Board were also advised that the work has begun by targeting building and energy related emissions and that initiatives have been piloted and rolled out nationally. These have been achieved through the development of Energy Management Teams at the Larger Energy User sites.

The Board advised that they would like to see outcomes of measures such as energy consumption and waste reflected in the Board Strategic Scorecard. It was noted that the development of metering and measurement systems would be essential to support this. In a discussion about the Energy Management Team, it was explained that the Energy Officer for each team is an additional resource and that the remaining function of the team is carried out by existing staff, who contribute to it in addition to their principal role.

In a discussion about fossil fuels, it was advised that it is intended to replace fossil fuel heating systems with heat pumps, which are electrically-driven and that the teams are also looking at the potential for utilising district heating. The Board were also advised that new technologies are being considered as part of the HSE’s Deep Energy Retrofit ‘Pathfinder’ Programme, which is being progressed in partnership with the Sustainability Energy Authority of Ireland (SEAI).

In a discussion relating to the amount of toxic waste that the HSE produces, it was advised that the first focus of a reduction must be the separation of waste and that groups will be established from the Steering Group next month.

In a discussion on how new buildings are being managed in the process, the Board were advised that developments to map to zero are ongoing and also that collaboration with other countries is being actively pursued.

The Board were informed that the DoH are very supportive of sustainable travel for patients and advised that a representative from the Ambulance Service is leading on developing a ‘green fleet’. A discussion was also had about whether access to healthcare is a consideration in the new ‘Busconnects’ scheme and discussions were had with regards to the role of voluntary organisations.

The CEO commended the report and advised of three key objectives of emissions targets: to stop growth of current behaviour, to reverse the current scale of consumption and to future-proof the plan.

The Board commented that the Employee Opinion Survey would be a good indicator of staff engagement and of the importance of an effective communications plan when publishing the report.

In a discussion on the decision-making process, it was advised that there should be a long term costsaving. The Board recommended focusing on the aspects that are measurable so as not to cause any delay by getting bogged down in complexity. A suggestion to re-wild the grounds of Dr Steevens’ Hospital was also made, as a visible sign of leadership and commitment to the strategy from the centre.

The Chair advised this report was presented at EU-level in November, as the EU is trying to develop its health remit and advised that the plan was greeted very positively and positives about the health and social care system in Ireland were expressed and was acknowledged as one of the reasons that Ireland’s Covid mortality was lower than that of the UK.

The Chair advised the Board that the next meeting of the Board will take place on Wednesday 31 May 2023 in person and will be a Board Strategy Day.

No further matters arose.

The meeting concluded at 2.35pm.