HSE board meeting minutes 26 July 2024

Attendance

Board members

Mr Ciarán Devane (Chairperson), Dr Yvonne Traynor (Board member), Mr Brendan Whelan (Board member), Mr Aogán Ó Fearghaíl (Board member), Ms Anne Carrigy (Board member), Mr Matt Walsh (Board member), Ms Michelle O’Sullivan (Board member), Mr Tim Hynes (Board member)

Office of the board

Mr Dara Purcell (Corporate Secretary), Ms Niamh Drew (Deputy Corporate Secretary), Ms Patricia Perry (Office of the Board)

In Attendance for Board Meeting:

Mr Bernard Gloster (Chief Executive Officer - CEO), Mr Brian Murphy (Head of Corporate Affairs), Ms Niamh Doody (CEO - Executive Business Manager)

Joined the meeting:

Mr Damien McCallion (Chief Technology & Transformation Officer CTTO), Mr Pat Healy (National Director, National Services and Schemes), Mr Tony Canavan (REO West & North West), Ms Sandra Broderick (REO Mid-West), Ms Sara Long (REO Dublin & North East), Ms Kate Killen White (REO Dublin & Midlands), Ms Martina Queally (REO Dublin & South East), Dr Andy Philips (REO South East), Ms Anne Marie Hoey (Chief People Officer CPO), Mr Joseph Duggan (Chief Internal Auditor CIA), Mr Mark Brennock (National Director, Communications & Public Affairs)

Mr Patrick Lynch (National Director Planning & Performance), Ms Grace Rothwell (National Director of Access & Integration (Designate)), Mr David Walsh (National Director, Community Operations), Mr Colum Maddox (Asst Chief Financial Officer), Mr Joe Hoare (AND Capital & Estates), Ms Philippa Withero (AND Human Resources)

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 members to the meeting and provided an update to the Board during their private session.

2.1 Declarations of Interest

No conflicts of interest were declared.

2.2 Chairperson’s Remarks

The Chairperson provided an update to the Board on the appointment of new Board Members. He informed the Board that he had also held discussions with the Chair of the Audit & Risk Committee, People & Culture Committee and the Technology and Transformation Committee regarding the initial design of a new Board Committee Structure. The Board discussed the proposal, and the approach was endorsed by the Board.

2.3 Ministerial Correspondence

The Board noted correspondence received relating to a letter from the Minister for Health re Approval of Capital Plan 2024 dated 04 July 2024.

2.4 Minutes of Board meeting

The Board approved the minutes of the Board meeting of 28 June 2024.

CEO and Executive Business Manager joined the meeting

3.1 CEO briefing to Board

The Chairperson welcomed the CEO to the meeting. The CEO provided an update to the Board on the Report from Justice Frank Clarke.

3.2 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 on progress with the implementation of the Waiting List Action Plan (WLAP) for 2024. The CEO informed the Board that a meeting was held on 19 July 2024 with the Minister for Health, Department of Health (DoH) officials and the REOs with a specific focus on OPD lists.

The Board discussed the WLAP noting that while activity has increased in many areas, caution must be noted to ensure that this is not a reflection of purely investment but increase of productivity. In relation to the remainder of the year it was noted that within Outpatient Services, increased capacity may have been attributable to a decrease in new referrals rather than increased activity however the Board welcomed the positive direction and it was agreed that further discussion would take place at the next Board meeting.

The Board noted the publication of the Annual Report of the Mental Health Commission (MHC), the CEO informed the Board that he met with the CEO of the MHC, and that a plan is in place to address issues raised. The Board welcomed the establishment of the new National Office for Child and Youth Mental Health team and the programme continues at pace.

The CEO also informed the Board that he attended the Cabinet Committee on Children Education and Disability, and senior HSE officials have had ongoing engagements with the Departments of Education; Children Equality, Disability, Integration & Youth (CEDIY) and An Taoiseach. Discussing recruitment into this area, the CEO advised that he has requested National HR to offer all 2024 Health and Social Care Professions (HSCP) graduates the opportunity to obtain permanent employment in Disability services.

Acknowledging that Unscheduled Care demand has remained consistently high, the Board noted that since mid-June there has been an increase in the presence of Covid-19 within the acute system.

The CEO confirmed that while over the past five weeks Covid-19 cases have plateaued, ED presentations and hospitalised cases are at a high level. However, there has not been a corresponding increase in ICU admissions.

In relation to the Respiratory Syncytial Virus (RSV) Prevention Program, the Board welcomed that formal approval had been received from the DoH, following a Memo to Government, which will target new-borns who are born between September 2024 and February 2025, and the DoH have approved expenditure for the cost. The implementation of the nasal seasonal flu vaccine (LAIV) to those aged 2-17 years old in 2024 – 2025 will now be delivered by each Regional Health Area.

The Board noted that the CTTO updated the Transformation and Technology Committee on 17 July 2024 in relation to the need to extend the contract on the current HPVP system procured during COVID-19 pending a further procurement process and an assessment of market response to HSE needs.

The Board noted ongoing discussions regarding the new HSE Corporate Plan 2025 - 2028 and that developments are advancing with engagements with the Chair and Board members.

The Board noted that the Productivity Unit reporting to the CEO has presented a Roadmap for Productivity to the DoH / HSE Taskforce, which is co-chaired by the CEO and it was agreed that a detailed briefing will be brought to the September Board meeting.

Development within the Health Regions continues with resourcing of the appointments of Finance and HR leads. The Board welcomed the appointment of Ms Grace Rothwell as National Director of Access & Integration (Designate).

Noting good progress on the uptake of the Public Only Consultant Contract (POCC), each REO provided an update to the Board in relation to the uptake in their area. The Board requested an analysis of data by each region regarding the implementation of the uptake of the POCC for the next Board meeting.

Board Strategic Scorecard

The CEO confirmed that scorecard #11 Patient and Service User Partnership reported a downgrade in its rating, all other scorecards maintained their rating. The Board approved the Board Strategic Scorecard for July 2024, reflecting May 2024 data, for submission to the Minister for Health, and the Department of Children, Equality, Disability, Integration and Youth.

4.1 Audit and Risk Committee

The minutes of the Committee meeting of 07 June 2024 were noted.

The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 12 July 2024 noting the YTD Financial Position as at May 2024, and the ‘bottom up’ 2024 projection exercise based on Q1 financial results, and welcomed the conclusion of the Pay and Numbers Strategy (PNS) and that the overall funding arrangement includes 2024 and 2025.

The Committee reviewed and discussed the C&AG Audit Cert, and management issues raised. The Special Legislative Accounts 2023 relating to Patient Private Property; Hepatitis C; Long Stay Repayments; and Long Stay Donations were noted, and an update provided in relation to the Internal Controls Improvement Programme. The Committee considered the detail of proposed contracts and properties and recommended approval to the Board.

The Committee were provided with an update in relation to the establishment of the Central Compliance Function (CCF), and welcomed that a draft multi-year implementation plan has been developed by the CCF.

An update was provided by the Chief Risk Officer in relation to the Q2 2024 CRR and the IA monthly report. The Committee also reviewed the draft Internal Audit Charter, and were updated in relation to the strategic considerations and direction of the IA Division

An update on the progress on the HSE Climate Action Strategy Implementation and the HSE’s Infrastructure Decarbonisation Roadmap was noted by the Committee.

The Committee discussed the National Children’s Hospital (NCH) Project and Programme, reviewed the Operational Readiness Review and noted the key actions. In relation to the programme management and programme oversight arrangements, in which the HSE has responsibility for programme funding and assurance, the Board discussed the importance of governance of oversight.

The Committee discussed the National Maternity Hospital (NMH) at St. Vincent’s University Hospital (SVUH) Programme – Governance and Resource Mobilisation, noted the summary of the key milestone timelines, and discussed the Programme Reporting Lines under the Programme Governance Structure, noting the responsibilities of the HSE.

The Committee noted the update on progress in relation to the Capital & Estates Strategy; and the

summary report on transactions approved between €2m & €10m and low value/nominal CAT 3a transactions for the period of 01 April – 30 June 2024.

Reappointment of External Member

The Chair of the Committee requested that the Board approve the reappointment of Mr Pat Kirwan as an external member of the Audit and Risk Committee for a further term of 1 year until 30 June 2025, which the Board approved.

Decision No.: 260724/29

The CEO informed the Board that the Annual Report and Financial Statements 2023 were laid before the Oireachtas by the Minister for Health on 25 July 2024.

4.2 People and Culture Committee

The minutes of the Committee meeting of 10 May 2024 were noted.

The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 16 July 2024 noting the Committee’s discussion on POCC Implementation and the role and responsibilities for decisions of Clinical Directors. The Committee had also highlighted that data available on HPVP should be presented by speciality to allow comparison across regions.

The Chair confirmed that the HR Bi-Monthly report was presented to the Committee, which included an update in relation to 2024 Health Service Excellence Awards; the Healthy Workplace Framework; the HSE Blended Working Policy for the Public Health Service; and a review of the Census data.

The Committee noted the Internal Management Data Dashboard related to Absenteeism, Time to Recruit, and Performance Achievement KPIs and were provided with an update the PNS; the National Taskforce on NCHD Workforce Final Recommendations Report; and the implementation of the priorities of the 2019-2024 People Strategy. The Committee noted that greater focus on culture be included in the next strategy.

The Committee received an update in relation to the responses to the 2023 Staff Survey; reviewed the 2 primary risks assigned to the Committee, and were provided with a brief on the progress of the Health Regions Programme.

4.3 Technology and Transformation Committee

The minutes of the Committee meeting of 15 May 2024 were noted.

The Committee Chairperson provided a verbal report on the matters considered at the Committee meeting that took place on 17 July 2024 noting that the overall status of the IFMS Project is reported as Off-Track against the IFMS Accelerated Plan, however ongoing corrective action is being taken, and progress against the adjusted workplan is being actively managed and monitored on a daily basis to mitigate the impact of these delays on the project and preserve the overall project timeline and go-live dates.

The Committee discussed three areas of the BSS with regard to the Health App, Shared Care Record (SCR), and Electronic Healthcare Record (EHR).

The Committee reviewed the CTTO report noting that the EHR steering group which will consider the business case for the rollout of EHR has been stood up; The Committee highlighted that the benefits of EHR will be significant in this context considering the differences between treating children and adults. Updates were provided to the Committee on the National Service Desk which is experiencing consistently high numbers of calls and it was agreed that information on the top 10 requests received would be provided to the Committee; that there were no major cyber incidents to report; and the current core initiatives for the Telehealth programme: Remote Consultations & Care: Video Enabled Care (VEC); Remote Health Monitoring - Virtual Wards; and Remote Health Monitoring - Remote Monitoring of Chronic Disease (‘Seedling’) Projects, which are being developed in line with the HSE Telehealth Roadmap 2024-2027.

The Committee were provided with an update on the implementation of the ICT Capital Plan 2024 which was developed to be fully aligned with the then emerging Digital Health Strategic Roadmap (DHSIR) and were presented with an update on the Healthcare Data Analytics Project, highlighting that Data Driven Services is one of the key principles of the new Digital Health Framework for Ireland.

The Committee noted the Q1 2024 Corporate Risk Register (CRR), the changes to CRR Risk 07 Cyber Security and the impact the upcoming Cybersecurity Maturity assessment will have on this risk.

5.1 Contracts and Properties

As recommended by the Audit & Risk Committee for approval, the Board considered and approved the following proposed contracts and properties:

1. Provision of Meningococcal Group B Vaccine on behalf of the HSE and all other Public Services to GlaxoSmithKline (GSK) Decision No.: 260724/30
2. Provision of Contracted Satellite Haemodialysis Unit for UL Hospital Group (Ennis) Decision No.: 260724/31
3. National Logistics Solution for Health Protection Products Decision No.: 260724/32
4. Provision of 100% Renewable Electricity Supply to the Health Service Executive & Health Sector Decision No.: 260724/33
5. Supply & Delivery of a Monoclonal Antibody for Respiratory Syncytial Virus (RSV) Passive immunisation of infants Decision No.: 260724/34
6. Award of Contract Sligo University Hospital Medical Block Decision No.: 260724/35

Colum Maddox, A/ CFO and Philippa Withero, AND HR joined the meeting

6.1 Pay and Numbers Strategy

The CEO advised the Board that engagements concluded with the Minister for Health, Minister for Public Expenditure, National Development Plan Delivery & Reform and the Cabinet Committee on Health, with the PNS agreed.

The Board were provided with the key aspects of the new PNS and the financial position underpinning same. The Board noted that for the first year in a long period, a further investment has been received into the base of the health allocation at an early time, which will allow for the commencement of interventions. He outlined that there are several challenging factors remaining, which will rely on the control environment and certain savings and efficiencies.

The Board welcomed that the Health Regions, National Services and Schemes and the HSE Centre now have clear WTE allocations, with specified number of WTEs, spend limit on agency and overtime. Each area will have the authority to manage its own staff allocation, and will not be affected by challenges should they occur in other parts of the organisation. The PNS in the Corporate HSE Centre will continue to be managed by the CEO, CPO, CFO and the National Director National Services and Schemes.

A reset of the PNS approved WTE for the health aspect of the HSE has been agreed and this is based on the outturn for 31 December 2023 (capturing and securing 4,000 positions unfunded) and its new ceiling for December 2024 of 129,753. An outline of the 3 stage control process to be taken with immediate effect were outlined, which will remain until the control mechanisms and culture are well established in advance of further development alongside the development of oversight systems that enable real time reporting.

An additional temporary control in relation to all non-capital non-pay spending was outlined by the CEO, all spending decisions of €20,000 or more must be approved in advance in writing by the REO / National Director Services and Schemes / CEO (via CFO) or nominated direct reports.

In relation to Section 38 agencies, it was outlined that REOs or any National Director’s contracting a Section 38 hospital or agency are required to issue directions to the organisation that they fully understand its pay control limit and WTE ceiling and operates within that, and its non-pay spend limit and adherence to same. The Board discussed the benefit in meeting with Boards of the Section 38 agencies to emphasise the importance in adhering to the controls, and it was agreed that a further discussion would be held in September.

The Board welcomed the conclusion of the PNS and the controls put in place, which enables the HSE to move forward with greater certainty for the remainder of the year and next year.

SLT left the meeting

There was no further business. The meeting concluded at 2.40pm.